| 1 | 1 | | 85R13434 LED-F |
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| 2 | 2 | | By: Gervin-Hawkins H.B. No. 3516 |
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| 3 | 3 | | |
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| 4 | 4 | | |
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| 5 | 5 | | A BILL TO BE ENTITLED |
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| 6 | 6 | | AN ACT |
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| 7 | 7 | | relating to reimbursement of health care providers under Medicaid. |
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| 8 | 8 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 9 | 9 | | SECTION 1. Subchapter A, Chapter 533, Government Code, is |
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| 10 | 10 | | amended by adding Section 533.0067 to read as follows: |
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| 11 | 11 | | Sec. 533.0067. PROVIDER NEGOTIATIONS. The commission shall |
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| 12 | 12 | | establish a process to allow a health care provider who provides |
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| 13 | 13 | | health care services to Medicaid recipients to negotiate with a |
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| 14 | 14 | | managed care organization that contracts with the commission to |
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| 15 | 15 | | provide health care services to recipients reimbursement rates that |
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| 16 | 16 | | are comparable to prevailing market rates. The commission shall |
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| 17 | 17 | | include the process developed under this section in each contract |
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| 18 | 18 | | between a managed care organization and the commission in addition |
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| 19 | 19 | | to all other contract provisions required by this chapter. |
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| 20 | 20 | | SECTION 2. The heading to Section 32.029, Human Resources |
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| 21 | 21 | | Code, is amended to read as follows: |
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| 22 | 22 | | Sec. 32.029. METHODS AND TIME FOR [OF] PAYMENT. |
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| 23 | 23 | | SECTION 3. Section 32.029, Human Resources Code, is amended |
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| 24 | 24 | | by adding Subsection (f) to read as follows: |
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| 25 | 25 | | (f) Subject to Subsection (d), the commission shall ensure |
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| 26 | 26 | | that, for any claim for medical assistance payment that is received |
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| 27 | 27 | | with documentation reasonably necessary for the payor to process |
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| 28 | 28 | | the claim, payment to a provider of health care services is |
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| 29 | 29 | | paid not later than: |
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| 30 | 30 | | (1) the 45th day after the date the claim is received; |
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| 31 | 31 | | or |
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| 32 | 32 | | (2) within a period specified by a written agreement |
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| 33 | 33 | | between the health care provider and the payor. |
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| 34 | 34 | | SECTION 4. The Health and Human Services Commission shall, |
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| 35 | 35 | | in a contract between the commission and a managed care |
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| 36 | 36 | | organization under Chapter 533, Government Code, that is entered |
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| 37 | 37 | | into or renewed on or after the effective date of this Act, require |
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| 38 | 38 | | that the managed care organization comply with the process |
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| 39 | 39 | | established under Section 533.0067, Government Code, as added by |
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| 40 | 40 | | this Act. |
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| 41 | 41 | | SECTION 5. Section 32.029, Human Resources Code, as amended |
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| 42 | 42 | | by this Act, applies to a claim for payment received on or after the |
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| 43 | 43 | | effective date of this Act. A claim for payment received before the |
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| 44 | 44 | | effective date of this Act is governed by the law in effect on the |
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| 45 | 45 | | date the claim was received, and the former law is continued in |
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| 46 | 46 | | effect for that purpose. |
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| 47 | 47 | | SECTION 6. If before implementing any provision of this Act |
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| 48 | 48 | | a state agency determines that a waiver or authorization from a |
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| 49 | 49 | | federal agency is necessary for implementation of that provision, |
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| 50 | 50 | | the agency affected by the provision shall request the waiver or |
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| 51 | 51 | | authorization and may delay implementing that provision until the |
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| 52 | 52 | | waiver or authorization is granted. |
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| 53 | 53 | | SECTION 7. This Act takes effect September 1, 2017. |
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