H.B. No. 3538 introduces the Managed Care Consumer Choice Program, amending the Government Code to establish new 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 commence 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 mandates the establishment of performance measures for evaluating MCOs based on quality and efficiency, with annual evaluations published for public access. It 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. The bill also includes provisions for extending existing contracts and outlines the timeline for entering into new contracts for various programs. If federal authorization is required for implementation, the state agency may delay the provision until granted. The act will take effect immediately upon a two-thirds vote or on September 1, 2025, if not.

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