Texas 2013 - 83rd Regular

Texas House Bill HB2731 Compare Versions

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1	1	83R22752 JSL-D
2	2	By: Raymond H.B. No. 2731
3	3	Substitute the following for H.B. No. 2731:
4	4	By: Raymond C.S.H.B. No. 2731
5	5
6	6
7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to decreasing administrative burdens of Medicaid managed
10	10	care for the state, the managed care organizations, and providers
11	11	under managed care networks.
12	12	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
13	13	SECTION 1. Section 533.0071, Government Code, is amended to
14	14	read as follows:
15	15	Sec. 533.0071. ADMINISTRATION OF CONTRACTS. The
16	16	commission shall make every effort to improve the administration of
17	17	contracts with managed care organizations. To improve the
18	18	administration of these contracts, the commission shall:
19	19	(1) ensure that the commission has appropriate
20	20	expertise and qualified staff to effectively manage contracts with
21	21	managed care organizations under the Medicaid managed care program;
22	22	(2) evaluate options for Medicaid payment recovery
23	23	from managed care organizations if the enrollee dies or is
24	24	incarcerated or if an enrollee is enrolled in more than one state
25	25	program or is covered by another liable third party insurer;
26	26	(3) maximize Medicaid payment recovery options by
27	27	contracting with private vendors to assist in the recovery of
28	28	capitation payments, payments from other liable third parties, and
29	29	other payments made to managed care organizations with respect to
30	30	enrollees who leave the managed care program;
31	31	(4) decrease the administrative burdens of managed
32	32	care for the state, the managed care organizations, and the
33	33	providers under managed care networks to the extent that those
34	34	changes are compatible with state law and existing Medicaid managed
35	35	care contracts, including decreasing those burdens by:
36	36	(A) where possible, decreasing the duplication
37	37	of administrative reporting requirements for the managed care
38	38	organizations, such as requirements for the submission of encounter
39	39	data, quality reports, historically underutilized business
40	40	reports, and claims payment summary reports;
41	41	(B) allowing managed care organizations to
42	42	provide updated address information directly to the commission for
43	43	correction in the state system;
44	44	(C) promoting consistency and uniformity among
45	45	managed care organization policies, including policies relating to
46	46	the [preauthorization process,] lengths of hospital stays, filing
47	47	deadlines, levels of care, and case management services;
48	48	(D) developing uniform efficiency standards and
49	49	requirements for managed care organizations for the submission and
50	50	tracking of preauthorization requests for services provided under
51	51	the Medicaid program [reviewing the appropriateness of primary
52	52	care case management requirements in the admission and clinical
53	53	criteria process, such as requirements relating to including a
54	54	separate cover sheet for all communications, submitting
55	55	handwritten communications instead of electronic or typed review
56	56	processes, and admitting patients listed on separate
57	57	notifications]; [and]
58	58	(E) providing a [single] portal through which
59	59	providers in any managed care organization's provider network may:
60	60	(i) submit electronic claims, prior
61	61	authorization requests, claims appeals, and reconsiderations,
62	62	clinical data, and other documentation that the managed care
63	63	organization requests for prior authorization and claims
64	64	processing; and
65	65	(ii) obtain electronic remittance advice,
66	66	explanation of benefits statements, and other standardized
67	67	reports; [and]
68	68	(F) requiring the use of standardized
69	69	application processes and forms for prompt credentialing of
70	70	providers in a managed care organization's network; and
71	71	(G) promoting prompt and accurate adjudication
72	72	of claims through:
73	73	(i) provider education on the proper
74	74	submission of clean claims and on appeals;
75	75	(ii) acceptance of uniform forms, including
76	76	the Centers for Medicare and Medicaid Services Forms 1500 and
77	77	UB-92, through an electronic portal; and
78	78	(iii) the establishment of standards for
79	79	claims payments in accordance with a provider's contract;
80	80	(5) reserve the right to amend the managed care
81	81	organization's process for resolving provider appeals of denials
82	82	based on medical necessity to include an independent review process
83	83	established by the commission for final determination of these
84	84	disputes;
85	85	(6) monitor and evaluate a managed care organization's
86	86	compliance with contractual requirements regarding:
87	87	(A) the reduction of administrative burdens for
88	88	network providers; and
89	89	(B) complaints regarding claims adjudication or
90	90	payment;
91	91	(7) measure the rates of retention by managed care
92	92	organizations of significant traditional providers; and
93	93	(8) develop adequate and clearly defined provider
94	94	network standards that are specific to provider type and that
95	95	ensure choice among multiple providers to the greatest extent
96	96	possible.
97	97	SECTION 2. If before implementing any provision of this Act
98	98	a state agency determines that a waiver or authorization from a
99	99	federal agency is necessary for implementation of that provision,
100	100	the agency affected by the provision shall request the waiver or
101	101	authorization and may delay implementing that provision until the
102	102	waiver or authorization is granted.
103	103	SECTION 3. This Act takes effect September 1, 2013.