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 to provide healthcare services to recipients. It sets forth requirements for these organizations, including certification of financial solvency and compliance with performance measures. The bill also mandates that contracts include specific provisions and that services cannot commence until a readiness review is completed. Additionally, it outlines the programs affected by this legislation, which include STAR, CHIP, STAR Kids, and STAR + PLUS, while excluding the STAR Health program.

Furthermore, the bill introduces performance measures to evaluate managed care organizations based on quality and efficiency, requiring annual evaluations and public reporting of results. It specifies that beginning September 1, 2027, the commission will contract with health plan providers through the Managed Care Consumer Choice Program, replacing the previous competitive procurement process. The bill also includes provisions for extending existing contracts and outlines the timeline for implementing new contracts under the Managed Care Consumer Choice Program. If federal authorization is needed for implementation, the state agency may delay the provision until such authorization is granted. The act will take effect immediately upon a two-thirds vote or on September 1, 2025, if that vote is not achieved.

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