H.B. No. 3538 establishes the Managed Care Consumer Choice Program in Texas, amending Chapter 533 of the Government Code by adding Sections 533.0021 and 533.0022. The bill allows the Health and Human Services Commission to issue requests for applications to contract with managed care organizations (MCOs) to provide healthcare services to recipients. It sets forth requirements for MCOs, including certification, financial solvency assurances, and compliance with performance measures. Contracts must include specific provisions and cannot take effect until the MCO completes a readiness review as mandated by federal law. The bill also outlines the programs affected, which include STAR, CHIP, STAR Kids, and STAR + PLUS, while excluding the STAR Health program.

Additionally, the bill introduces performance measures for evaluating MCOs based on their quality and efficiency in the Texas Medicaid and CHIP market. The commission is tasked with publishing selection criteria for MCOs and conducting annual evaluations of their performance. The bill specifies that starting September 1, 2027, the commission will contract with health plan providers through the Managed Care Consumer Choice Program, replacing the previous competitive procurement process. It also mandates that existing contracts with MCOs for certain programs be extended until new contracts are established, with a timeline for implementing the new program by September 1, 2030.

Statutes affected:
Introduced: Health and Safety Code 62.155 (Health and Safety Code 62)