83R4639 KKR-D
By: Martinez H.B. No. 2632
A BILL TO BE ENTITLED
AN ACT
relating to reimbursement for certain ambulance services provided
to persons enrolled in the Medicaid managed care program and the
inclusion of certain ambulance service providers in the health care
provider networks of Medicaid managed care organizations.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter A, Chapter 533, Government Code, is
amended by adding Section 533.0067 to read as follows:
Sec. 533.0067. AMBULANCE SERVICE PROVIDERS. Subject to
Section 32.047, Human Resources Code, and any other provision that
excludes a provider based on the provider's conduct that
constitutes fraud, waste, or abuse, but notwithstanding any other
law, the commission shall require that each managed care
organization that contracts with the commission under any Medicaid
managed care model or arrangement to provide health care services
to recipients in a region:
(1) include in the organization's provider network
each person providing ambulance services in the region who:
(A) agrees to comply with the terms and
conditions of the organization;
(B) agrees to abide by the standards of care
required by the organization; and
(C) has the credentials required by the
organization; and
(2) negotiate in good faith with each ambulance
service provider identified in Subdivision (1), including
negotiating in good faith to reimburse the provider at a rate that
is equal to at least 95 percent of the allowable rate for ambulance
services under Section 32.028, Human Resources Code.
SECTION 2. Subchapter A, Chapter 533, Government Code, is
amended by adding Section 533.01316 to read as follows:
Sec. 533.01316. REIMBURSEMENT FOR CERTAIN AMBULANCE
SERVICES. (a) This section applies with respect to a recipient of
medical assistance who is an enrollee in a managed care plan under
any Medicaid managed care model or arrangement.
(b) The commission shall ensure that a person providing
ambulance services to a Medicaid managed care enrollee is
reimbursed for nonemergency services provided to the enrollee at a
rate that is equal to:
(1) the allowable rate for those services as
determined under Section 32.028, Human Resources Code, if the
services are provided by a provider who is not in the applicable
Medicaid managed care plan's service area or network of providers;
or
(2) at least 95 percent of the allowable rate for those
services as determined under Section 32.028, Human Resources Code,
if the services are provided by a provider who is in the applicable
Medicaid managed care plan's service area but who is not in the
plan's network of providers.
(c) The commission shall ensure that a person providing
ambulance services to a Medicaid managed care enrollee is
reimbursed for emergency services provided to the enrollee 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 services are provided by a provider in the applicable
Medicaid managed care plan's area of service or network of
providers.
SECTION 3. (a) The Health and Human Services Commission
shall, in a contract between the commission and a Medicaid managed
care organization under Chapter 533, Government Code, that is
entered into or renewed on or after the effective date of this Act,
require that the managed care organization comply with Sections
533.0067 and 533.01316, Government Code, as added by this Act.
(b) The Health and Human Services Commission shall seek to
amend each contract entered into with a Medicaid managed care
organization under Chapter 533, Government Code, before the
effective date of this Act to require those managed care
organizations to comply with Sections 533.0067 and 533.01316,
Government Code, as added by this Act. To the extent of a conflict
between Sections 533.0067 and 533.01316, Government Code, as added
by this Act, and a provision of a contract with a managed care
organization entered into before the effective date of this Act,
the contract provision prevails.
SECTION 4. 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 5. This Act takes effect September 1, 2013.