87R24267 KKR-F
By: Raymond, Guillen H.B. No. 4047
Substitute the following for H.B. No. 4047:
By: Frank C.S.H.B. No. 4047
A BILL TO BE ENTITLED
AN ACT
relating to allowing health care providers to enter certain claims
and other information into the Medicaid electronic visit
verification system.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. 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) complete electronic visit
verification system data maintenance within the 95-day period
following the date of a service delivery visit; and
(iii) submit a claim to be reimbursed for an
amount of time that:
(a) does not exceed the amount of
authorized hours unless the additional hours are approved by the
commission or the managed care organization; and
(b) is equal to or less than the
appropriately verified amount of time.
SECTION 2. 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 3. This Act takes effect September 1, 2021.