LEGISLATIVE BUDGET BOARD Austin, Texas FISCAL NOTE, 84TH LEGISLATIVE REGULAR SESSION April 12, 2015 TO: Honorable Myra Crownover, Chair, House Committee on Public Health FROM: Ursula Parks, Director, Legislative Budget Board IN RE:HB3464 by Muñoz, Jr. (Relating to the processing and payment of claims for reimbursement by providers under the Medicaid program.), As Introduced There could be significant costs related to implementing the provisions of the bill, but because needed system modifications at managed care organizations and pharmacy benefit managers are unknown, the fiscal impact to the state cannot be determined. The bill would amend Chapter 533 of the Government Code to amend and add to required contract provisions between the Health and Human Services Commission (HHSC) and managed care organizations that a managed care organization make a payment to a physician or provider for health care services no later than 15 days after the receipt of a claim for payment and that a managed care organization allow a physician or provider to electronically submit documentation necessary to process a claim, including additional or amended documentation. These new requirements would also apply to pharmacy benefit managers.Certain managed care organizations and pharmacy benefit managers may need to modify systems to accommodate the reduced time frame for processing claims, which could impact the administrative rate HHSC pays to those plans. There could be significant costs related to implementing the provisions of the bill, but because needed system modifications at managed care organizations and pharmacy benefit managers are unknown, the fiscal impact to the state cannot be determined. Local Government Impact No fiscal implication to units of local government is anticipated. Source Agencies:529 Health and Human Services Commission LBB Staff: UP, NB, WP, LR, CH, CL, MB
LEGISLATIVE BUDGET BOARD
Austin, Texas
FISCAL NOTE, 84TH LEGISLATIVE REGULAR SESSION
April 12, 2015
TO: Honorable Myra Crownover, Chair, House Committee on Public Health FROM: Ursula Parks, Director, Legislative Budget Board IN RE:HB3464 by Muñoz, Jr. (Relating to the processing and payment of claims for reimbursement by providers under the Medicaid program.), As Introduced
TO: Honorable Myra Crownover, Chair, House Committee on Public Health
FROM: Ursula Parks, Director, Legislative Budget Board
IN RE: HB3464 by Muñoz, Jr. (Relating to the processing and payment of claims for reimbursement by providers under the Medicaid program.), As Introduced
Honorable Myra Crownover, Chair, House Committee on Public Health
Honorable Myra Crownover, Chair, House Committee on Public Health
Ursula Parks, Director, Legislative Budget Board
Ursula Parks, Director, Legislative Budget Board
HB3464 by Muñoz, Jr. (Relating to the processing and payment of claims for reimbursement by providers under the Medicaid program.), As Introduced
HB3464 by Muñoz, Jr. (Relating to the processing and payment of claims for reimbursement by providers under the Medicaid program.), As Introduced
There could be significant costs related to implementing the provisions of the bill, but because needed system modifications at managed care organizations and pharmacy benefit managers are unknown, the fiscal impact to the state cannot be determined.
There could be significant costs related to implementing the provisions of the bill, but because needed system modifications at managed care organizations and pharmacy benefit managers are unknown, the fiscal impact to the state cannot be determined.
The bill would amend Chapter 533 of the Government Code to amend and add to required contract provisions between the Health and Human Services Commission (HHSC) and managed care organizations that a managed care organization make a payment to a physician or provider for health care services no later than 15 days after the receipt of a claim for payment and that a managed care organization allow a physician or provider to electronically submit documentation necessary to process a claim, including additional or amended documentation. These new requirements would also apply to pharmacy benefit managers.Certain managed care organizations and pharmacy benefit managers may need to modify systems to accommodate the reduced time frame for processing claims, which could impact the administrative rate HHSC pays to those plans. There could be significant costs related to implementing the provisions of the bill, but because needed system modifications at managed care organizations and pharmacy benefit managers are unknown, the fiscal impact to the state cannot be determined.
Local Government Impact
No fiscal implication to units of local government is anticipated.
Source Agencies: 529 Health and Human Services Commission
529 Health and Human Services Commission
LBB Staff: UP, NB, WP, LR, CH, CL, MB
UP, NB, WP, LR, CH, CL, MB