Texas 2021 - 87th Regular

Texas House Bill HB4047 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	87R24267 KKR-F
2		-	By: Raymond, Guillen H.B. No. 4047
3		-	Substitute the following for H.B. No. 4047:
4		-	By: Frank C.S.H.B. No. 4047
	1	+	By: Raymond H.B. No. 4047
5	2
6	3
7	4		A BILL TO BE ENTITLED
8	5		AN ACT
9		-	relating to ~~allowing health care providers to enter certain claims~~
10		-	~~and other information into the Medicaid electronic visit~~
11		-	~~verification system~~.
	6	+	relating to claims processes and reimbursement for, and overpayment
	7	+	recoupment processes imposed on, health care providers under
	8	+	Medicaid.
12	9		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
13		-	SECTION 1. Section 531.024172(d), Government Code, is
	10	+	SECTION 1. Section 531.1135(c), Government Code, is amended
	11	+	to read as follows:
	12	+	(c) Notwithstanding any other law, a managed care
	13	+	organization may not attempt to recover an overpayment described by
	14	+	Subsection (a) until:
	15	+	(1) the provider has exhausted all rights to an
	16	+	appeal; and
	17	+	(2) the office of the inspector general has issued a
	18	+	final determination.
	19	+	SECTION 2. Section 531.024172(d), Government Code, is
14	20		amended to read as follows:
15	21		(d) In implementing the electronic visit verification
16	22		system:
17	23		(1) subject to Subsection (e), the executive
18	24		commissioner shall adopt compliance standards for health care
19	25		providers; and
20	26		(2) the commission shall ensure that:
21	27		(A) the information required to be reported by
22	28		health care providers is standardized across managed care
23	29		organizations that contract with the commission to provide health
24	30		care services to Medicaid recipients and across commission
25	31		programs;
26	32		(B) processes required by managed care
27	33		organizations to retrospectively correct data are standardized and
28	34		publicly accessible to health care providers; [and]
29	35		(C) standardized processes are established for
30	36		addressing the failure of a managed care organization to provide a
31	37		timely authorization for delivering services necessary to ensure
32	38		continuity of care; and
33	39		(D) a health care provider is allowed to:
34	40		(i) enter a variable schedule into the
35		-	electronic visit verification system;
36		-	(ii) complete electronic visit
37		-	verification system data maintenance within the 95-day period
38		-	following the date of a service delivery visit; and
39		-	(iii) submit a claim to be reimbursed for an
40		-	amount of time that:
41		-	(a) does not exceed the amount of
42		-	authorized hours unless the additional hours are approved by the
43		-	commission or the managed care organization; and
44		-	(b) is equal to or less than the
45		-	appropriately verified amount of time.
46		-	SECTION 2. If before implementing any provision of this Act
	41	+	electronic visit verification system,
	42	+	(ii) submit a claim to be reimbursed for an
	43	+	amount of time that is less than the verified amount of time; and
	44	+	(iii) correct claims denied by a managed
	45	+	care organization within 95 days of the date of denial.
	46	+	SECTION 3. If before implementing any provision of this Act
47	47		a state agency determines that a waiver or authorization from a
48	48		federal agency is necessary for implementation of that provision,
49	49		the agency affected by the provision shall request the waiver or
50	50		authorization and may delay implementing that provision until the
51	51		waiver or authorization is granted.
52		-	SECTION 3. This Act takes effect September 1, 2021.
	52	+	SECTION 5. This Act takes effect September 1, 2021.