Texas 2019 - 86th Regular

Texas House Bill HB2221 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	By: Raymond H.B. No. 2221
2	2
3	3
4	4	A BILL TO BE ENTITLED
5	5	AN ACT
6	6	relating to a single Internet portal through which Medicaid
7	7	providers may submit and receive information.
8	8	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
9	9	SECTION 1. Section 533.0055, Government Code, is amended by
10	10	amending Subsection (b) and adding Subsections (c), (d), and (e) to
11	11	read as follows:
12	12	(b) The provider protection plan required under this
13	13	section must provide for:
14	14	(1) prompt payment and proper reimbursement of
15	15	providers by managed care organizations;
16	16	(2) prompt and accurate adjudication of claims
17	17	through:
18	18	(A) provider education on the proper submission
19	19	of clean claims and on appeals;
20	20	(B) acceptance of uniform forms, including HCFA
21	21	Forms 1500 and UB-92 and subsequent versions of those forms,
22	22	through an electronic portal; and
23	23	(C) the establishment of standards for claims
24	24	payments in accordance with a provider's contract;
25	25	(3) adequate and clearly defined provider network
26	26	standards that are specific to provider type, including physicians,
27	27	general acute care facilities, and other provider types defined in
28	28	the commission's network adequacy standards in effect on January 1,
29	29	2013, and that ensure choice among multiple providers to the
30	30	greatest extent possible;
31	31	(4) a prompt credentialing process for providers;
32	32	(5) uniform efficiency standards and requirements for
33	33	managed care organizations for the submission and tracking of
34	34	preauthorization requests for services provided under Medicaid;
35	35	(6) establishment and maintenance of an [electronic
36	36	process, including the use of an] Internet portal[,] through which
37	37	providers in any managed care organization's provider network may:
38	38	(A) submit electronic claims, prior
39	39	authorization requests, claims appeals and reconsiderations,
40	40	clinical data, and other documentation that the managed care
41	41	organization requests for prior authorization and claims
42	42	processing; and
43	43	(B) obtain electronic remittance advice,
44	44	explanation of benefits statements, and other standardized
45	45	reports;
46	46	(7) the measurement of the rates of retention by
47	47	managed care organizations of significant traditional providers;
48	48	(8) the creation of a work group to review and make
49	49	recommendations to the commission concerning any requirement under
50	50	this subsection for which immediate implementation is not feasible
51	51	at the time the plan is otherwise implemented, including the
52	52	required process for submission and acceptance of attachments for
53	53	claims processing and prior authorization requests through the
54	54	Internet portal required by [an electronic process under]
55	55	Subdivision (6) and, for any requirement that is not implemented
56	56	immediately, recommendations regarding the expected:
57	57	(A) fiscal impact of implementing the
58	58	requirement; and
59	59	(B) timeline for implementation of the
60	60	requirement; and
61	61	(9) any other provision that the commission determines
62	62	will ensure efficiency or reduce administrative burdens on
63	63	providers participating in a Medicaid managed care model or
64	64	arrangement.
65	65	(c) The commission shall consolidate each electronic or
66	66	Internet portal operated or maintained by the commission, including
67	67	through a contract with a separate entity, that is used to receive
68	68	and deliver requests and other information from and to Medicaid
69	69	providers, including nursing facility providers participating in
70	70	the STAR+PLUS Medicaid managed care program, into the single
71	71	Internet portal required by Subsection (b)(6).
72	72	The commission
73	73	shall ensure the single Internet portal meets the requirements of a
74	74	portal described by Sections 531.02411, 533.00251, 533.002553, and
75	75	533.0071.
76	76	(d) The commission may contract with a private or nonprofit
77	77	entity to develop, operate, and maintain the single Internet portal
78	78	required by Subsection (b)(6). The entity may not be affiliated
79	79	with any specific managed care plan.
80	80	(e) Notwithstanding any other law, the executive
81	81	commissioner by rule shall require each managed care organization
82	82	to allow providers in the organization's provider network to use
83	83	the single Internet portal required by Subsection (b)(6).
84	84	SECTION 2. Not later than January 1, 2021, the Health and
85	85	Human Services Commission, or an entity with whom the commission
86	86	contracts, shall develop and implement the single Internet portal
87	87	required by Section 533.0055, Government Code, as amended by this
88	88	Act.
89	89	SECTION 3. This Act takes effect September 1, 2019.