82S10093 EES-D
By: Guillen H.B. No. 36
A BILL TO BE ENTITLED
AN ACT
relating to reimbursement for health care services provided at
certain times to persons enrolled in the Medicaid managed care
program.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 533.01315, Government Code, is amended
by amending Subsection (b) and adding Subsection (b-1) to read as
follows:
(b) Subject to Subsection (b-1), the [The] commission shall
ensure that a federally qualified health center, physician office,
urgent care facility, rural health clinic, or municipal health
department's public clinic is reimbursed for health care services
provided to a recipient outside of regular business hours,
including on a weekend or holiday, at a rate that is equal to the
allowable rate for those services as determined under Section
32.028, Human Resources Code, regardless of whether the recipient
has a referral from the recipient's primary care provider.
(b-1) A physician who is a specialist may not be reimbursed
under this section for the provision of specialty services.
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 on the 91st day after the
last day of the legislative session.