Texas 2009 - 81st Regular

Texas Senate Bill SB2424 Compare Versions

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Old	New	Differences
1	1	S.B. No. 2424
2	2
3	3
4	4	AN ACT
5	5	relating to the authorization of certain nonemergency ambulance
6	6	services under the Medicaid program.
7	7	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
8	8	SECTION 1. Subsection (t), Section 32.024, Human Resources
9	9	Code, is amended to read as follows:
10	10	(t) The department by rule shall require a physician,
11	11	nursing facility, health care provider, or other responsible party
12	12	to obtain authorization from the department or a person authorized
13	13	to act on behalf of the department on the same day or the next
14	14	business day following the day of transport when [before] an
15	15	ambulance is used to transport a recipient of medical assistance
16	16	under this chapter in circumstances not involving an emergency and
17	17	the request is for the authorization of the provision of
18	18	transportation for only one day. If the request is for
19	19	authorization of the provision of transportation on more than one
20	20	day, the department by rule shall require a physician, nursing
21	21	facility, health care provider, or other responsible party to
22	22	obtain a single authorization before an ambulance is used to
23	23	transport a recipient of medical assistance under this chapter in
24	24	circumstances not involving an emergency. The rules must provide
25	25	that:
26	26	(1) except as provided by Subdivision (3), a request
27	27	for authorization must be evaluated based on the recipient's
28	28	medical needs and may be granted for a length of time appropriate to
29	29	the recipient's medical condition;
30	30	(2) except as provided by Subdivision (3), a response
31	31	to a request for authorization must be made not later than 48 hours
32	32	after receipt of the request;
33	33	(3) a request for authorization must be immediately
34	34	granted and must be effective for a period of not more than 180 days
35	35	from the date of issuance if the request includes a written
36	36	statement from a physician that:
37	37	(A) states that alternative means of
38	38	transporting the recipient are contraindicated; and
39	39	(B) is dated not earlier than the 60th day before
40	40	the date on which the request for authorization is made;
41	41	(4) a person denied payment for ambulance services
42	42	rendered is entitled to payment from the nursing facility, health
43	43	care provider, or other responsible party that requested the
44	44	services if:
45	45	(A) payment under the medical assistance program
46	46	is denied because of lack of prior authorization; and
47	47	(B) the person provides the nursing facility,
48	48	health care provider, or other responsible party with a copy of the
49	49	bill for which payment was denied; [and]
50	50	(5) a person denied payment for services rendered
51	51	because of failure to obtain prior authorization or because a
52	52	request for prior authorization was denied is entitled to appeal
53	53	the denial of payment to the department; and
54	54	(6) the department or a person authorized to act on
55	55	behalf of the department must be available to evaluate requests for
56	56	authorization under this subsection not less than 12 hours each
57	57	day, excluding weekends and state holidays.
58	58	SECTION 2. If before implementing any provision of this Act
59	59	a state agency determines that a waiver or authorization from a
60	60	federal agency is necessary for implementation of that provision,
61	61	the agency affected by the provision shall request the waiver or
62	62	authorization and may delay implementing that provision until the
63	63	waiver or authorization is granted.
64	64	SECTION 3. This Act takes effect immediately if it receives
65	65	a vote of two-thirds of all the members elected to each house, as
66	66	provided by Section 39, Article III, Texas Constitution. If this
67	67	Act does not receive the vote necessary for immediate effect, this
68	68	Act takes effect September 1, 2009.
69	69	______________________________ ______________________________
70	70	President of the Senate Speaker of the House
71	71	I hereby certify that S.B. No. 2424 passed the Senate on
72	72	April 27, 2009, by the following vote: Yeas 31, Nays 0.
73	73	______________________________
74	74	Secretary of the Senate
75	75	I hereby certify that S.B. No. 2424 passed the House on
76	76	May 27, 2009, by the following vote: Yeas 148, Nays 0, one
77	77	present not voting.
78	78	______________________________
79	79	Chief Clerk of the House
80	80	Approved:
81	81	______________________________
82	82	Date
83	83	______________________________
84	84	Governor