83R10419 ADM-F
By: Eiland H.B. No. 3452
A BILL TO BE ENTITLED
AN ACT
relating to administrative and judicial review of certain Medicaid
reimbursement disputes.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter B, Chapter 531, Government Code, is
amended by adding Subsection 531.02115 to read as follows:
Sec. 531.02115. ADMINISTRATIVE AND JUDICIAL REVIEW OF
REIMBURSEMENT DISPUTES UNDER MEDICAID PROGRAM. (a) A provider has
the right to a contested case hearing to dispute the amount of a
reimbursement rate paid to the provider under the fee-for-service
Medicaid program or by a managed care organization under the
managed care Medicaid program if the provider maintains that the
rate is below the rate necessary to recover the provider's
reasonable operating expenses and to realize a reasonable return on
the provider's investments that is sufficient to ensure confidence
in the provider's continued financial integrity.
(b) A contested case hearing under this section must be
conducted by a hearing officer in the manner provided for contested
case hearings under Subchapter C, Chapter 2001.
(c) Parties to a contested case hearing under this section
must include:
(1) the commission; and
(2) in a dispute involving a payment made by a managed
care organization, the managed care organization.
(d) Exhaustion of contractual remedies with a managed care
organization or its agent is not a prerequisite to a contested case
hearing under this section.
(e) In the absence of a timely appeal for judicial review
under Subsection (f), the decision of a hearing officer under this
section is final.
(f) Judicial review of a decision or order of a hearing
officer is governed by Subchapter G, Chapter 2001, except that the
party seeking judicial review must file suit not later than the 45th
day after the date notice of the decision made by the hearing
officer was mailed.
SECTION 2. The change in law made by this Act applies only
to a reimbursement paid to a Medicaid provider on or after the
effective date of this Act.
SECTION 3. 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 4. This Act takes effect immediately if it receives
a vote of two-thirds of all the members elected to each house, as
provided by Section 39, Article III, Texas Constitution. If this
Act does not receive the vote necessary for immediate effect, this
Act takes effect September 1, 2013.