S.B. No. 531
AN ACT
relating to the medical assistance program and 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. Section 32.024, Human Resources Code, is amended
by adding Subsection (ii) to read as follows:
(ii) The department shall provide medical assistance
reimbursement to a pharmacist who is licensed to practice pharmacy
in this state, is authorized to administer immunizations in
accordance with rules adopted by the Texas State Board of Pharmacy,
and administers an immunization to a recipient of medical
assistance to the same extent the department provides reimbursement
to a physician or other health care provider participating in the
medical assistance program for the administration of that
immunization.
SECTION 3. Subchapter B, Chapter 32, Human Resources Code,
is amended by adding Section 32.0424 to read as follows:
Sec. 32.0424. REQUIREMENTS OF THIRD-PARTY HEALTH INSURERS.
(a) A third-party health insurer is required to provide to the
department, on the department's request, information in a form
prescribed by the department necessary to determine:
(1) the period during which an individual entitled to
medical assistance, the individual's spouse, or the individual's
dependents may be, or may have been, covered by coverage issued by
the health insurer;
(2) the nature of the coverage; and
(3) the name, address, and identifying number of the
health plan under which the person may be, or may have been,
covered.
(b) A third-party health insurer shall accept the state's
right of recovery and the assignment under Section 32.033 to the
state of any right of an individual or other entity to payment from
the third-party health insurer for an item or service for which
payment was made under the medical assistance program.
(c) A third-party health insurer shall respond to any
inquiry by the department regarding a claim for payment for any
health care item or service reimbursed by the department under the
medical assistance program not later than the third anniversary of
the date the health care item or service was provided.
(d) A third-party health insurer may not deny a claim
submitted by the department or the department's designee for which
payment was made under the medical assistance program solely on the
basis of the date of submission of the claim, the type or format of
the claim form, or a failure to present proper documentation at the
point of service that is the basis of the claim, if:
(1) the claim is submitted by the department or the
department's designee not later than the third anniversary of the
date the item or service was provided; and
(2) any action by the department or the department's
designee to enforce the state's rights with respect to the claim is
commenced not later than the sixth anniversary of the date the
department or the department's designee submits the claim.
(e) This section does not limit the scope or amount of
information required by Section 32.042.
SECTION 4. 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 5. 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 6. This Act takes effect September 1, 2009.
______________________________ ______________________________
President of the Senate Speaker of the House
I hereby certify that S.B. No. 531 passed the Senate on
March 25, 2009, by the following vote: Yeas 31, Nays 0; and that
the Senate concurred in House amendments on May 29, 2009, by the
following vote: Yeas 31, Nays 0.
______________________________
Secretary of the Senate
I hereby certify that S.B. No. 531 passed the House, with
amendments, on May 27, 2009, by the following vote: Yeas 147,
Nays 1, one present not voting.
______________________________
Chief Clerk of the House
Approved:
______________________________
Date
______________________________
Governor