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Texas Statutes (Last Updated: January 4, 2014) |
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GOVERNMENT CODE |
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Title 4. EXECUTIVE BRANCH |
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Subtitle I. HEALTH AND HUMAN SERVICES |
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Chapter 533. IMPLEMENTATION OF MEDICAID MANAGED CARE PROGRAM |
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Subchapter A. GENERAL PROVISIONS |
Sec. 533.003. CONSIDERATIONS IN AWARDING CONTRACTS
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(a) In awarding contracts to managed care organizations, the commission shall:
(1) give preference to organizations that have significant participation in the organization's provider network from each health care provider in the region who has traditionally provided care to Medicaid and charity care patients;
(2) give extra consideration to organizations that agree to assure continuity of care for at least three months beyond the period of Medicaid eligibility for recipients;
(3) consider the need to use different managed care plans to meet the needs of different populations;
(4) consider the ability of organizations to process Medicaid claims electronically; and
(5) in the initial implementation of managed care in the South Texas service region, give extra consideration to an organization that either:
(A) is locally owned, managed, and operated, if one exists; or
(B) is in compliance with the requirements of Section 533.004.
(b) The commission, in considering approval of a subcontract between a managed care organization and a pharmacy benefit manager for the provision of prescription drug benefits under the Medicaid program, shall review and consider whether the pharmacy benefit manager has been in the preceding three years:
(1) convicted of an offense involving a material misrepresentation or an act of fraud or of another violation of state or federal criminal law;
(2) adjudicated to have committed a breach of contract; or
(3) assessed a penalty or fine in the amount of $500,000 or more in a state or federal administrative proceeding.