By: Buckingham S.B. No. 1235
(In the Senate - Filed February 27, 2019; March 7, 2019,
read first time and referred to Committee on Health & Human
Services; April 23, 2019, reported adversely, with favorable
Committee Substitute by the following vote: Yeas 9, Nays 0;
April 23, 2019, sent to printer.)
Click here to see the committee vote
COMMITTEE SUBSTITUTE FOR S.B. No. 1235 By: Perry
A BILL TO BE ENTITLED
AN ACT
relating to the enrollment of health care providers in Medicaid.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 531.02118, Government Code, is amended
by amending Subsection (c) and adding Subsections (e), (f), (g),
(h), and (i) to read as follows:
(c) In streamlining the Medicaid provider credentialing
process under this section, the commission may designate a
centralized credentialing entity and shall require [may]:
(1) that the credentialing entity and the entity
serving as the state's Medicaid claims administrator share
information to reduce the submission of duplicative information or
documents necessary for both Medicaid enrollment and credentialing
[in the database established under Subchapter C, Chapter 32, Human
Resources Code, with the centralized credentialing entity]; and
(2) [require] all managed care organizations
contracting with the commission to provide health care services to
Medicaid recipients under a managed care plan issued by the
organization to use the centralized credentialing entity as a hub
for the collection and sharing of information.
(e) Subject to Subsection (f), the commission shall enroll a
provider as a Medicaid provider, without requiring the provider to
separately apply for enrollment through the entity serving as the
state's Medicaid claims administrator, if the provider is:
(1) credentialed by a managed care organization that
contracts with the commission under Chapter 533; or
(2) enrolled as a Medicare provider.
(f) The executive commissioner by rule may establish
additional enrollment requirements that are:
(1) necessary to enroll a provider as a Medicaid
provider; and
(2) not otherwise required by managed care
organization credentialing or Medicare provider enrollment.
(g) The commission shall track the number of providers that
enroll as Medicaid providers through each type of enrollment
process described by Subsection (e), including the enrollment
process through the entity serving as the state's Medicaid claims
administrator.
(h) The commission shall develop a process to streamline the
Medicaid enrollment of a provider who:
(1) provides services through a single case agreement
to a recipient who is also enrolled in a private group health
benefit plan; and
(2) is enrolled as a provider in that group health
benefit plan.
(i) The commission shall use a provider's national provider
identifier number to enroll a provider under Subsection (h). In
this subsection, "national provider identifier number" means the
national provider identifier number required under Section
1128J(e), Social Security Act (42 U.S.C. Section 1320a-7k(e)).
SECTION 2. 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 3. The Health and Human Services Commission is
required to implement a provision of this Act only if the
legislature appropriates money specifically for that purpose. If
the legislature does not appropriate money specifically for that
purpose, the commission may, but is not required to, implement a
provision of this Act using other appropriations available for that
purpose.
SECTION 4. This Act takes effect September 1, 2019.
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