By: Hinojosa S.B. No. 2086
(In the Senate - Filed March 7, 2019; March 21, 2019, read
first time and referred to Committee on Health & Human Services;
May 9, 2019, reported adversely, with favorable Committee
Substitute by the following vote: Yeas 9, Nays 0; May 9, 2019, sent
to printer.)
COMMITTEE SUBSTITUTE FOR S.B. No. 2086 By: Perry
A BILL TO BE ENTITLED
AN ACT
relating to a single Internet portal or equivalent electronic
system 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), (e), and
(f) 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 interoperable electronic portal or equivalent
electronic system; 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 interoperable
[electronic process, including the use of an] Internet portal or
equivalent electronic system with real-time capabilities [,]
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 or equivalent electronic system 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, using existing resources, shall
consolidate each electronic or Internet portal operated or
maintained by the commission for the commission's use, 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 or equivalent electronic system required by
Subsection (b)(6). The commission shall:
(1) ensure the single Internet portal or equivalent
electronic system meets the requirements of a portal described by
Sections 531.02411, 533.00251, 533.002553, and 533.0071; and
(2) implement a method that allows:
(A) each managed care organization to connect
with the single Internet portal or equivalent electronic system;
and
(B) a provider to access the single Internet
portal or equivalent electronic system both directly and through a
managed care organization's Internet website.
(d) The commission may contract with a private or nonprofit
entity to develop, operate, and maintain the single Internet portal
or equivalent electronic system required by Subsection (b)(6). The
entity may not be affiliated with any specific managed care plan,
the Texas Medicaid and Healthcare Partnership, or another entity
serving as the state's Medicaid claims administrator.
(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 or equivalent
electronic system required by Subsection (b)(6).
(f) Notwithstanding any other law, a provider in a managed
care organization's provider network may continue to use a provider
portal made available by the managed care organization that is
interoperable with the single Internet portal or equivalent
electronic system, as applicable, required by Subsection (b)(6)
instead of accessing the single Internet portal or equivalent
electronic system directly.
SECTION 2. Not later than January 1, 2021, the Health and
Human Services Commission, or an entity with which the commission
contracts, shall develop and implement the single Internet portal
or equivalent electronic system required by Section 533.0055,
Government Code, as amended by this Act.
SECTION 3. This Act takes effect immediately if it receives
a vote of two-thirds of all the members elected to each house, as
provided by Section 39, Article III, Texas Constitution. If this
Act does not receive the vote necessary for immediate effect, this
Act takes effect September 1, 2019.
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