85R13434 LED-F
By: Gervin-Hawkins H.B. No. 3516
A BILL TO BE ENTITLED
AN ACT
relating to reimbursement of health care providers under Medicaid.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter A, Chapter 533, Government Code, is
amended by adding Section 533.0067 to read as follows:
Sec. 533.0067. PROVIDER NEGOTIATIONS. The commission shall
establish a process to allow a health care provider who provides
health care services to Medicaid recipients to negotiate with a
managed care organization that contracts with the commission to
provide health care services to recipients reimbursement rates that
are comparable to prevailing market rates. The commission shall
include the process developed under this section in each contract
between a managed care organization and the commission in addition
to all other contract provisions required by this chapter.
SECTION 2. The heading to Section 32.029, Human Resources
Code, is amended to read as follows:
Sec. 32.029. METHODS AND TIME FOR [OF] PAYMENT.
SECTION 3. Section 32.029, Human Resources Code, is amended
by adding Subsection (f) to read as follows:
(f) Subject to Subsection (d), the commission shall ensure
that, for any claim for medical assistance payment that is received
with documentation reasonably necessary for the payor to process
the claim, payment to a provider of health care services is
paid not later than:
(1) the 45th day after the date the claim is received;
or
(2) within a period specified by a written agreement
between the health care provider and the payor.
SECTION 4. The Health and Human Services Commission shall,
in a contract between the commission and a managed care
organization under Chapter 533, Government Code, that is entered
into or renewed on or after the effective date of this Act, require
that the managed care organization comply with the process
established under Section 533.0067, Government Code, as added by
this Act.
SECTION 5. Section 32.029, Human Resources Code, as amended
by this Act, applies to a claim for payment received on or after the
effective date of this Act. A claim for payment received before the
effective date of this Act is governed by the law in effect on the
date the claim was received, and the former law is continued in
effect for that purpose.
SECTION 6. 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 7. This Act takes effect September 1, 2017.