86R8048 JG-D
By: Hinojosa S.B. No. 2086
A BILL TO BE ENTITLED
AN ACT
relating to a single Internet portal through which Medicaid
providers may submit and receive information.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 533.0055, Government Code, is amended by
amending Subsection (b) and adding Subsections (c), (d), and (e) to
read as follows:
(b) The provider protection plan required under this
section must provide for:
(1) prompt payment and proper reimbursement of
providers by managed care organizations;
(2) prompt and accurate adjudication of claims
through:
(A) provider education on the proper submission
of clean claims and on appeals;
(B) acceptance of uniform forms, including HCFA
Forms 1500 and UB-92 and subsequent versions of those forms,
through an electronic portal; and
(C) the establishment of standards for claims
payments in accordance with a provider's contract;
(3) adequate and clearly defined provider network
standards that are specific to provider type, including physicians,
general acute care facilities, and other provider types defined in
the commission's network adequacy standards in effect on January 1,
2013, and that ensure choice among multiple providers to the
greatest extent possible;
(4) a prompt credentialing process for providers;
(5) uniform efficiency standards and requirements for
managed care organizations for the submission and tracking of
preauthorization requests for services provided under Medicaid;
(6) establishment and maintenance of an [electronic
process, including the use of an] Internet portal[,] through which
providers in any managed care organization's provider network may:
(A) submit electronic claims, prior
authorization requests, claims appeals and reconsiderations,
clinical data, and other documentation that the managed care
organization requests for prior authorization and claims
processing; and
(B) obtain electronic remittance advice,
explanation of benefits statements, and other standardized
reports;
(7) the measurement of the rates of retention by
managed care organizations of significant traditional providers;
(8) the creation of a work group to review and make
recommendations to the commission concerning any requirement under
this subsection for which immediate implementation is not feasible
at the time the plan is otherwise implemented, including the
required process for submission and acceptance of attachments for
claims processing and prior authorization requests through the
Internet portal required by [an electronic process under]
Subdivision (6) and, for any requirement that is not implemented
immediately, recommendations regarding the expected:
(A) fiscal impact of implementing the
requirement; and
(B) timeline for implementation of the
requirement; and
(9) any other provision that the commission determines
will ensure efficiency or reduce administrative burdens on
providers participating in a Medicaid managed care model or
arrangement.
(c) The commission shall consolidate each electronic or
Internet portal operated or maintained by the commission, including
through a contract with a separate entity, that is used to receive
and deliver requests and other information from and to Medicaid
providers, including nursing facility providers participating in
the STAR+PLUS Medicaid managed care program, into the single
Internet portal required by Subsection (b)(6). The commission shall
ensure the single Internet portal meets the requirements of a
portal described by Sections 531.02411, 533.00251, 533.002553, and
533.0071.
(d) The commission may contract with a private or nonprofit
entity to develop, operate, and maintain the single Internet portal
required by Subsection (b)(6). The entity may not be affiliated
with any specific managed care plan.
(e) The executive commissioner by rule shall require each
managed care organization to allow providers in the organization's
provider network to use the single Internet portal required by
Subsection (b)(6).
SECTION 2. Not later than January 1, 2021, the Health and
Human Services Commission, or an entity with whom the commission
contracts, shall develop and implement the single Internet portal
required by Section 533.0055, Government Code, as amended by this
Act.
SECTION 3. This Act takes effect September 1, 2019.