TX SB2093

Expands eligibility for expedited credentialing in Medicaid managed care to include providers who are members of federally qualified health centers (FQHCs) with existing managed care organization contracts, in addition to established health care provider groups

Requires managed care plan issuers to confirm application completeness or request missing information within 5 business days, and render a credentialing decision within 10 business days of receiving a complete application

Mandates that applicants be treated as participating providers for payment purposes during the credentialing process, allowing their FQHC to collect copayments and receive in-network benefit payments

Protects enrollees by holding them harmless for any difference between in-network and out-of-network costs if a provider ultimately fails to meet credentialing requirements

Allows managed care plan issuers to recover the difference between in-network and out-of-network payments from providers or their FQHCs if credentialing is ultimately denied, while limiting issuer liability for complying with these expedited credentialing provisions