Update: The status of Medicaid managed care legislation in Texas

Over the past several weeks, Texas has been considering many bills which seek to provide additional protections to Medicaid Managed Care recipients. We have been tracking the progress of one of the largest and most expensive reforms introduced.

 

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House Bill 2453, which would’ve created more protections for low-income and disabled Texans by requiring a third party review of medical denials and appeals, died last week  despite the fact that it bill progressed through the House Health and Human Services committee.

Following the House Health and Human Services committee hearing, in which several managed care organizations expressed opposition, the bill was held in limbo for nearly a week before being sent to the calendar. Given the limited time frame left this session, the bill did not make it to calendar consideration before the deadline for passage.

“I was disappointed that HB 2453 died, but not all that surprised,” Rep. Sarah Davis, the sponsor of the bill, said in an interview with The Dallas Morning News. “We always knew making major reforms was an uphill battle.The MCOs were fighting us every step of the way,” she continued during the interview.

The bill was the most expansive in a set of legislation that seeks additional protections for managed care programs and patients.

The issue of managed care has a history in Texas, most notably following a series by The Dallas Morning News that detailed several controversial stories around managed care mismanagement. You can read more about the context of those stories and the legislation that followed, here.

Although HB 2453 will not progress any further this session, there are other bills that make critical changes to managed care protocol that are still in play. Here are some other bills that have attempted to make changes to managed care this session:

Senate Bill 1096 creates a series of requirements for pharmacy benefits received through the Medicaid Managed Care program. Many of the requirements attempt to provide transparency to the services received through the managed care program, and to establish additional accountability to make sure that these vital services are received in a timely manner.

The bill was heard in the House Health and Human Services committee yesterday and has been sent to the calendar for consideration.

Senate Bill 1105 requires the state to better track and monitor denials of medical services to be created increased accountability. The bill is in response to the claims made in the Morning News series that detailed many of these lapses in accountability.

The bill was referred to the House Health and Human Services committee last week and is pending consideration.

Senate Bill 1140 creates an external medical review for the medicaid managed care process. It would allow patients and families to have an additional opportunity to appeal a medical denial for life-sustaining medical equipment and treatment. This is one of the more broad bills in the managed care package this session.

The bill was referred to the House Health and Human Services committee for consideration in late April. It is still alive for consideration and eventual passage, because it originated in the opposite chamber.

Senate Bill 1207 focuses on a narrow population of individuals who receive managed care treatment, creating additional protections for sick and disabled children to prevent lapses in coverage.

The bill was considered in the House Health and Human Services committee yesterday and has been sent to the calendar for recording and consideration.

While there is no hope that the broad measure to create Medicaid Managed Care protections will advance this session, the other pieces of legislation are still active and could advance ahead of session adjournment on May 27.