Texas 2013 - 83rd Regular

Texas House Bill HB3452 Compare Versions

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1	1	83R10419 ADM-F
2	2	By: Eiland H.B. No. 3452
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to administrative and judicial review of certain Medicaid
8	8	reimbursement disputes.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Subchapter B, Chapter 531, Government Code, is
11	11	amended by adding Subsection 531.02115 to read as follows:
12	12	Sec. 531.02115. ADMINISTRATIVE AND JUDICIAL REVIEW OF
13	13	REIMBURSEMENT DISPUTES UNDER MEDICAID PROGRAM. (a) A provider has
14	14	the right to a contested case hearing to dispute the amount of a
15	15	reimbursement rate paid to the provider under the fee-for-service
16	16	Medicaid program or by a managed care organization under the
17	17	managed care Medicaid program if the provider maintains that the
18	18	rate is below the rate necessary to recover the provider's
19	19	reasonable operating expenses and to realize a reasonable return on
20	20	the provider's investments that is sufficient to ensure confidence
21	21	in the provider's continued financial integrity.
22	22	(b) A contested case hearing under this section must be
23	23	conducted by a hearing officer in the manner provided for contested
24	24	case hearings under Subchapter C, Chapter 2001.
25	25	(c) Parties to a contested case hearing under this section
26	26	must include:
27	27	(1) the commission; and
28	28	(2) in a dispute involving a payment made by a managed
29	29	care organization, the managed care organization.
30	30	(d) Exhaustion of contractual remedies with a managed care
31	31	organization or its agent is not a prerequisite to a contested case
32	32	hearing under this section.
33	33	(e) In the absence of a timely appeal for judicial review
34	34	under Subsection (f), the decision of a hearing officer under this
35	35	section is final.
36	36	(f) Judicial review of a decision or order of a hearing
37	37	officer is governed by Subchapter G, Chapter 2001, except that the
38	38	party seeking judicial review must file suit not later than the 45th
39	39	day after the date notice of the decision made by the hearing
40	40	officer was mailed.
41	41	SECTION 2. The change in law made by this Act applies only
42	42	to a reimbursement paid to a Medicaid provider on or after the
43	43	effective date of this Act.
44	44	SECTION 3. If before implementing any provision of this Act
45	45	a state agency determines that a waiver or authorization from a
46	46	federal agency is necessary for implementation of that provision,
47	47	the agency affected by the provision shall request the waiver or
48	48	authorization and may delay implementing that provision until the
49	49	waiver or authorization is granted.
50	50	SECTION 4. This Act takes effect immediately if it receives
51	51	a vote of two-thirds of all the members elected to each house, as
52	52	provided by Section 39, Article III, Texas Constitution. If this
53	53	Act does not receive the vote necessary for immediate effect, this
54	54	Act takes effect September 1, 2013.