Texas 2019 - 86th Regular

Texas Senate Bill SB2086 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1	1		By: Hinojosa S.B. No. 2086
	2	+	(In the Senate - Filed March 7, 2019; March 21, 2019, read
	3	+	first time and referred to Committee on Health & Human Services;
	4	+	May 9, 2019, reported adversely, with favorable Committee
	5	+	Substitute by the following vote: Yeas 9, Nays 0; May 9, 2019, sent
	6	+	to printer.)
	7	+	COMMITTEE SUBSTITUTE FOR S.B. No. 2086 By: Perry
2	8
3	9
4	10		A BILL TO BE ENTITLED
5	11		AN ACT
6	12		relating to a single Internet portal or equivalent electronic
7	13		system through which Medicaid providers may submit and receive
8	14		information.
9	15		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	16		SECTION 1. Section 533.0055, Government Code, is amended by
11	17		amending Subsection (b) and adding Subsections (c), (d), (e), and
12	18		(f) to read as follows:
13	19		(b) The provider protection plan required under this
14	20		section must provide for:
15	21		(1) prompt payment and proper reimbursement of
16	22		providers by managed care organizations;
17	23		(2) prompt and accurate adjudication of claims
18	24		through:
19	25		(A) provider education on the proper submission
20	26		of clean claims and on appeals;
21	27		(B) acceptance of uniform forms, including HCFA
22	28		Forms 1500 and UB-92 and subsequent versions of those forms,
23	29		through an interoperable electronic portal or equivalent
24	30		electronic system; and
25	31		(C) the establishment of standards for claims
26	32		payments in accordance with a provider's contract;
27	33		(3) adequate and clearly defined provider network
28	34		standards that are specific to provider type, including physicians,
29	35		general acute care facilities, and other provider types defined in
30	36		the commission's network adequacy standards in effect on January 1,
31	37		2013, and that ensure choice among multiple providers to the
32	38		greatest extent possible;
33	39		(4) a prompt credentialing process for providers;
34	40		(5) uniform efficiency standards and requirements for
35	41		managed care organizations for the submission and tracking of
36	42		preauthorization requests for services provided under Medicaid;
37	43		(6) establishment and maintenance of an interoperable
38	44		[electronic process, including the use of an] Internet portal or
39	45		equivalent electronic system with real-time capabilities [,]
40	46		through which providers in any managed care organization's provider
41	47		network may:
42	48		(A) submit electronic claims, prior
43	49		authorization requests, claims appeals and reconsiderations,
44	50		clinical data, and other documentation that the managed care
45	51		organization requests for prior authorization and claims
46	52		processing; and
47	53		(B) obtain electronic remittance advice,
48	54		explanation of benefits statements, and other standardized
49	55		reports;
50	56		(7) the measurement of the rates of retention by
51	57		managed care organizations of significant traditional providers;
52	58		(8) the creation of a work group to review and make
53	59		recommendations to the commission concerning any requirement under
54	60		this subsection for which immediate implementation is not feasible
55	61		at the time the plan is otherwise implemented, including the
56	62		required process for submission and acceptance of attachments for
57	63		claims processing and prior authorization requests through the
58	64		Internet portal or equivalent electronic system required by [an
59	65		electronic process under] Subdivision (6) and, for any requirement
60	66		that is not implemented immediately, recommendations regarding the
61	67		expected:
62	68		(A) fiscal impact of implementing the
63	69		requirement; and
64	70		(B) timeline for implementation of the
65	71		requirement; and
66	72		(9) any other provision that the commission determines
67	73		will ensure efficiency or reduce administrative burdens on
68	74		providers participating in a Medicaid managed care model or
69	75		arrangement.
70	76		(c) The commission, using existing resources, shall
71	77		consolidate each electronic or Internet portal operated or
72	78		maintained by the commission for the commission's use, including
73	79		through a contract with a separate entity, that is used to receive
74	80		and deliver requests and other information from and to Medicaid
75	81		providers, including nursing facility providers participating in
76	82		the STAR+PLUS Medicaid managed care program, into the single
77	83		Internet portal or equivalent electronic system required by
78	84		Subsection (b)(6). The commission shall:
79	85		(1) ensure the single Internet portal or equivalent
80	86		electronic system meets the requirements of a portal described by
81	87		Sections 531.02411, 533.00251, 533.002553, and 533.0071; and
82	88		(2) implement a method that allows:
83	89		(A) each managed care organization to connect
84	90		with the single Internet portal or equivalent electronic system;
85	91		and
86	92		(B) a provider to access the single Internet
87	93		portal or equivalent electronic system both directly and through a
88	94		managed care organization's Internet website.
89	95		(d) The commission may contract with a private or nonprofit
90	96		entity to develop, operate, and maintain the single Internet portal
91	97		or equivalent electronic system required by Subsection (b)(6). The
92		-	entity may not be affiliated with any specific managed care plan.
	98	+	entity may not be affiliated with any specific managed care plan,
	99	+	the Texas Medicaid and Healthcare Partnership, or another entity
	100	+	serving as the state's Medicaid claims administrator.
93	101		(e) The executive commissioner by rule shall require each
94	102		managed care organization to allow providers in the organization's
95	103		provider network to use the single Internet portal or equivalent
96	104		electronic system required by Subsection (b)(6).
97	105		(f) Notwithstanding any other law, a provider in a managed
98	106		care organization's provider network may continue to use a provider
99	107		portal made available by the managed care organization that is
100	108		interoperable with the single Internet portal or equivalent
101	109		electronic system, as applicable, required by Subsection (b)(6)
102	110		instead of accessing the single Internet portal or equivalent
103	111		electronic system directly.
104	112		SECTION 2. Not later than January 1, 2021, the Health and
105	113		Human Services Commission, or an entity with which the commission
106	114		contracts, shall develop and implement the single Internet portal
107	115		or equivalent electronic system required by Section 533.0055,
108	116		Government Code, as amended by this Act.
109	117		SECTION 3. This Act takes effect immediately if it receives
110	118		a vote of two-thirds of all the members elected to each house, as
111	119		provided by Section 39, Article III, Texas Constitution. If this
112	120		Act does not receive the vote necessary for immediate effect, this
113	121		Act takes effect September 1, 2019.
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