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 health care 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. The programs affected include STAR, CHIP, STAR Kids, and STAR + PLUS, while excluding the STAR Health program.

Additionally, the bill introduces performance measures to evaluate managed care organizations based on cost efficiency, quality of care, and member satisfaction. It requires the commission to publish selection criteria for managed care organizations and to evaluate their performance annually. The bill also stipulates 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. Existing contracts will be extended until new ones are established, and the Managed Care Consumer Choice Program will be the exclusive method for entering into new contracts for the specified programs after the bill's effective date.

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