Texas 2021 - 87th Regular

Texas House Bill HB1625 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	87R6076 JG-D
2	2	By: Raymond H.B. No. 1625
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to a single Internet portal or equivalent electronic
8	8	system through which Medicaid providers may submit and receive
9	9	information.
10	10	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	11	SECTION 1. Section 533.0055, Government Code, is amended by
12	12	amending Subsection (b) and adding Subsections (c), (d), (e), and
13	13	(f) to read as follows:
14	14	(b) The provider protection plan required under this
15	15	section must provide for:
16	16	(1) prompt payment and proper reimbursement of
17	17	providers by managed care organizations;
18	18	(2) prompt and accurate adjudication of claims
19	19	through:
20	20	(A) provider education on the proper submission
21	21	of clean claims and on appeals;
22	22	(B) acceptance of uniform forms, including HCFA
23	23	Forms 1500 and UB-92 and subsequent versions of those forms,
24	24	through an interoperable electronic portal or equivalent
25	25	electronic system; and
26	26	(C) the establishment of standards for claims
27	27	payments in accordance with a provider's contract;
28	28	(3) adequate and clearly defined provider network
29	29	standards that are specific to provider type, including physicians,
30	30	general acute care facilities, and other provider types defined in
31	31	the commission's network adequacy standards in effect on January 1,
32	32	2013, and that ensure choice among multiple providers to the
33	33	greatest extent possible;
34	34	(4) a prompt credentialing process for providers;
35	35	(5) uniform efficiency standards and requirements for
36	36	managed care organizations for the submission and tracking of
37	37	preauthorization requests for services provided under Medicaid;
38	38	(6) establishment and maintenance of an interoperable
39	39	[electronic process, including the use of an] Internet portal or
40	40	equivalent electronic system with real-time capabilities [,]
41	41	through which providers in any managed care organization's provider
42	42	network may:
43	43	(A) submit electronic claims, prior
44	44	authorization requests, claims appeals and reconsiderations,
45	45	clinical data, and other documentation that the managed care
46	46	organization requests for prior authorization and claims
47	47	processing; and
48	48	(B) obtain electronic remittance advice,
49	49	explanation of benefits statements, and other standardized
50	50	reports;
51	51	(7) the measurement of the rates of retention by
52	52	managed care organizations of significant traditional providers;
53	53	(8) the creation of a work group to review and make
54	54	recommendations to the commission concerning any requirement under
55	55	this subsection for which immediate implementation is not feasible
56	56	at the time the plan is otherwise implemented, including the
57	57	required process for submission and acceptance of attachments for
58	58	claims processing and prior authorization requests through the
59	59	Internet portal or equivalent electronic system required by [an
60	60	electronic process under] Subdivision (6) and, for any requirement
61	61	that is not implemented immediately, recommendations regarding the
62	62	expected:
63	63	(A) fiscal impact of implementing the
64	64	requirement; and
65	65	(B) timeline for implementation of the
66	66	requirement; and
67	67	(9) any other provision that the commission determines
68	68	will ensure efficiency or reduce administrative burdens on
69	69	providers participating in a Medicaid managed care model or
70	70	arrangement.
71	71	(c) The commission, using existing resources, shall
72	72	consolidate each electronic or Internet portal operated or
73	73	maintained by the commission for the commission's use, including
74	74	through a contract with a separate entity, that is used to receive
75	75	and deliver requests and other information from and to Medicaid
76	76	providers, including nursing facility providers participating in
77	77	the STAR+PLUS Medicaid managed care program, into the single
78	78	Internet portal or equivalent electronic system required by
79	79	Subsection (b)(6). The commission shall:
80	80	(1) ensure the single Internet portal or equivalent
81	81	electronic system meets the requirements of a portal described by
82	82	Sections 531.02411, 533.00251, 533.002553, and 533.0071; and
83	83	(2) implement a method that allows:
84	84	(A) each managed care organization to connect
85	85	with the single Internet portal or equivalent electronic system;
86	86	and
87	87	(B) a provider to access the single Internet
88	88	portal or equivalent electronic system both directly and through a
89	89	managed care organization's Internet website.
90	90	(d) The commission may contract with a private or nonprofit
91	91	entity to develop, operate, and maintain the single Internet portal
92	92	or equivalent electronic system required by Subsection (b)(6). The
93	93	entity may not be affiliated with any specific managed care plan.
94	94	(e) The executive commissioner by rule shall require each
95	95	managed care organization to allow providers in the organization's
96	96	provider network to use the single Internet portal or equivalent
97	97	electronic system required by Subsection (b)(6).
98	98	(f) Notwithstanding any other law, a provider in a managed
99	99	care organization's provider network may continue to use a provider
100	100	portal made available by the managed care organization that is
101	101	interoperable with the single Internet portal or equivalent
102	102	electronic system, as applicable, required by Subsection (b)(6)
103	103	instead of accessing the single Internet portal or equivalent
104	104	electronic system directly.
105	105	SECTION 2. Not later than January 1, 2023, the Health and
106	106	Human Services Commission, or an entity with which the commission
107	107	contracts, shall develop and implement the single Internet portal
108	108	or equivalent electronic system required by Section 533.0055,
109	109	Government Code, as amended by this Act.
110	110	SECTION 3. This Act takes effect immediately if it receives
111	111	a vote of two-thirds of all the members elected to each house, as
112	112	provided by Section 39, Article III, Texas Constitution. If this
113	113	Act does not receive the vote necessary for immediate effect, this
114	114	Act takes effect September 1, 2021.