S.B. No. 2424
AN ACT
relating to the authorization of certain nonemergency ambulance
services under the Medicaid program.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subsection (t), Section 32.024, Human Resources
Code, is amended to read as follows:
(t) The department by rule shall require a physician,
nursing facility, health care provider, or other responsible party
to obtain authorization from the department or a person authorized
to act on behalf of the department on the same day or the next
business day following the day of transport when [before] an
ambulance is used to transport a recipient of medical assistance
under this chapter in circumstances not involving an emergency and
the request is for the authorization of the provision of
transportation for only one day. If the request is for
authorization of the provision of transportation on more than one
day, the department by rule shall require a physician, nursing
facility, health care provider, or other responsible party to
obtain a single authorization before an ambulance is used to
transport a recipient of medical assistance under this chapter in
circumstances not involving an emergency. The rules must provide
that:
(1) except as provided by Subdivision (3), a request
for authorization must be evaluated based on the recipient's
medical needs and may be granted for a length of time appropriate to
the recipient's medical condition;
(2) except as provided by Subdivision (3), a response
to a request for authorization must be made not later than 48 hours
after receipt of the request;
(3) a request for authorization must be immediately
granted and must be effective for a period of not more than 180 days
from the date of issuance if the request includes a written
statement from a physician that:
(A) states that alternative means of
transporting the recipient are contraindicated; and
(B) is dated not earlier than the 60th day before
the date on which the request for authorization is made;
(4) a person denied payment for ambulance services
rendered is entitled to payment from the nursing facility, health
care provider, or other responsible party that requested the
services if:
(A) payment under the medical assistance program
is denied because of lack of prior authorization; and
(B) the person provides the nursing facility,
health care provider, or other responsible party with a copy of the
bill for which payment was denied; [and]
(5) a person denied payment for services rendered
because of failure to obtain prior authorization or because a
request for prior authorization was denied is entitled to appeal
the denial of payment to the department; and
(6) the department or a person authorized to act on
behalf of the department must be available to evaluate requests for
authorization under this subsection not less than 12 hours each
day, excluding weekends and state holidays.
SECTION 2. If before implementing any provision of this Act
a state agency determines that a waiver or authorization from a
federal agency is necessary for implementation of that provision,
the agency affected by the provision shall request the waiver or
authorization and may delay implementing that provision until the
waiver or authorization is granted.
SECTION 3. This Act takes effect immediately if it receives
a vote of two-thirds of all the members elected to each house, as
provided by Section 39, Article III, Texas Constitution. If this
Act does not receive the vote necessary for immediate effect, this
Act takes effect September 1, 2009.
______________________________ ______________________________
President of the Senate Speaker of the House
I hereby certify that S.B. No. 2424 passed the Senate on
April 27, 2009, by the following vote: Yeas 31, Nays 0.
______________________________
Secretary of the Senate
I hereby certify that S.B. No. 2424 passed the House on
May 27, 2009, by the following vote: Yeas 148, Nays 0, one
present not voting.
______________________________
Chief Clerk of the House
Approved:
______________________________
Date
______________________________
Governor