Texas House Bill HB335

Texas 2017 - 85th Regular

• Filed: 11/15/16

Caption

Relating to administrative and judicial review of certain Medicaid reimbursement disputes; authorizing a fee.

Impact

The bill mandates that providers have the right to contest reimbursement rates they believe to be confiscatory through a due process hearing. The hearings must be held by an administrative law judge, emphasizing the importance of a fair and impartial review in determining whether these rates are appropriate. If a provider's dispute is found valid, the judge can direct the managed care organization to adjust its reimbursement rate accordingly. By introducing this framework, HB335 enhances the ability of Medicaid providers to challenge adverse financial conditions imposed by managed care entities, which could lead to greater financial viability for these providers.

Summary

House Bill 335 addresses the administrative and judicial review of Medicaid reimbursement disputes. The legislation seeks to prohibit managed care organizations from paying 'confiscatory' reimbursement rates to providers, which are defined as rates that do not allow providers to recover reasonable operating expenses, achieve a reasonable return on costs, and maintain confidence in their financial integrity. This provision aims to ensure that providers participating in Medicaid programs can sustain their operations and provide necessary services without financial loss due to inadequate reimbursement rates.

Contention

One notable point of contention surrounding HB335 is its potential financial implications for managed care organizations. Critics express concern that the requirement to adjust reimbursement rates could lead to increased costs for these organizations, which might have downstream effects on Medicaid funding and other budgetary concerns. Additionally, the administrative processes for disputing rates may place added burdens on both providers and the entities tasked with adjudicating these disputes. Stakeholders must balance providers' rights to fair reimbursement against the operational realities faced by managed care organizations, ensuring the legislation supports a sustainable Medicaid system overall.