Texas House Bill HB3212

Texas 2019 - 86th Regular

Caption

Relating to the procedure for the payment of claims submitted by certain providers under the Medicaid managed care program.

Impact

Should HB3212 be enacted, it will significantly impact the interactions between healthcare providers and managed care organizations within the Medicaid program. By ensuring that MCOs maintain transparency and rigor in their claims processing, the bill aims to protect providers from potentially unjust reductions in reimbursement rates. This provision seeks to foster a more trustworthy environment for providers, enhancing their ability to deliver necessary care under the Medicaid framework.

Summary

House Bill 3212 aims to amend processes related to the payment of claims by certain healthcare providers under the Medicaid managed care program. The bill stipulates that managed care organizations (MCOs) cannot alter the diagnosis or treatment codes associated with claims in a way that results in lower reimbursement rates for providers without specific conditions. These conditions require the evaluation and subsequent decision to amend a claim to be made by a physician employed by the managed care organization. Additionally, providers must be informed of the reasons for any changes made to their claims.

Contention

Discussion around HB3212 may involve potential points of contention related to the operational freedoms of managed care organizations. Some stakeholders might argue that the bill imposes undue constraints on MCOs, potentially inhibiting their ability to manage costs effectively. Conversely, advocates for the bill will likely emphasize the importance of protecting healthcare providers and ensuring fair compensation for services rendered, outlining the bill as a necessary step towards accountability within the Medicaid system.