By: Raymond H.B. No. 4047
A BILL TO BE ENTITLED
AN ACT
relating to claims processes and reimbursement for, and overpayment
recoupment processes imposed on, health care providers under
Medicaid.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 531.1135(c), Government Code, is amended
to read as follows:
(c) Notwithstanding any other law, a managed care
organization may not attempt to recover an overpayment described by
Subsection (a) until:
(1) the provider has exhausted all rights to an
appeal; and
(2) the office of the inspector general has issued a
final determination.
SECTION 2. Section 531.024172(d), Government Code, is
amended to read as follows:
(d) In implementing the electronic visit verification
system:
(1) subject to Subsection (e), the executive
commissioner shall adopt compliance standards for health care
providers; and
(2) the commission shall ensure that:
(A) the information required to be reported by
health care providers is standardized across managed care
organizations that contract with the commission to provide health
care services to Medicaid recipients and across commission
programs;
(B) processes required by managed care
organizations to retrospectively correct data are standardized and
publicly accessible to health care providers; [and]
(C) standardized processes are established for
addressing the failure of a managed care organization to provide a
timely authorization for delivering services necessary to ensure
continuity of care; and
(D) a health care provider is allowed to:
(i) enter a variable schedule into the
electronic visit verification system,
(ii) submit a claim to be reimbursed for an
amount of time that is less than the verified amount of time; and
(iii) correct claims denied by a managed
care organization within 95 days of the date of denial.
SECTION 3. 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 5. This Act takes effect September 1, 2021.