By: Patrick, Nichols S.B. No. 531
A BILL TO BE ENTITLED
AN ACT
relating to the billing coordination system for claims submitted
for payment from the Medicaid program.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 531.02413, Government Code, as added by
Chapter 268 (S.B. 10), Acts of the 80th Legislature, Regular
Session, 2007, is amended by adding Subsection (a-1) and amending
Subsections (b) and (c) to read as follows:
(a-1) If cost-effective and feasible, the commission shall
contract to expand the Medicaid billing coordination system
described by Subsection (a) to process claims for all other health
care services provided through the Medicaid program in the manner
claims for acute care services are processed by the system under
Subsection (a). This subsection does not apply to claims for health
care services provided through the Medicaid program if, before
September 1, 2009, those claims were being processed by an
alternative billing coordination system.
(b) If cost-effective, the executive commissioner shall
adopt rules for the purpose of enabling the system described by
Subsection (a) to identify an entity with primary responsibility
for paying a claim that is processed by the system under Subsection
(a) and establish reporting requirements for any entity that may
have a contractual responsibility to pay for the types of [acute
care] services that are provided under the Medicaid program and the
claims for which are processed by the system under Subsection (a).
(c) An entity that holds a permit, license, or certificate
of authority issued by a regulatory agency of the state must allow a
[the] contractor under this section [Subsection (a)] access to
databases to allow the contractor to carry out the purposes of this
section, subject to the contractor's contract with the commission
and rules adopted under this section, and is subject to an
administrative penalty or other sanction as provided by the law
applicable to the permit, license, or certificate of authority for
a violation by the entity of a rule adopted under this section.
SECTION 2. The Health and Human Services Commission may
seek to amend an existing contract entered into under Section
531.02413, Government Code, as added by Chapter 268 (S.B. 10), Acts
of the 80th Legislature, Regular Session, 2007, or may enter into a
new contract, to implement the changes made to that section by this
Act.
SECTION 3. 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 4. This Act takes effect September 1, 2009.