Texas 2023 - 88th Regular

Texas Senate Bill SB1342 Compare Versions

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Version 2 (New)

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1	1	S.B. No. 1342
2	2
3	3
4	4	AN ACT
5	5	relating to requirements applicable to certain third-party health
6	6	insurers in relation to Medicaid.
7	7	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
8	8	SECTION 1. Section 531.024131(a), Government Code, is
9	9	amended to read as follows:
10	10	(a) If cost-effective, the commission may:
11	11	(1) contract to expand all or part of the billing
12	12	coordination system established under Section 531.02413 to process
13	13	claims for services provided through other benefits programs
14	14	administered by the commission or a health and human services
15	15	agency;
16	16	(2) expand any other billing coordination tools and
17	17	resources used to process claims for health care services provided
18	18	through Medicaid to process claims for services provided through
19	19	other benefits programs administered by the commission or a health
20	20	and human services agency; and
21	21	(3) expand the scope of persons about whom information
22	22	is collected under Section 32.0424(a) [32.042], Human Resources
23	23	Code, to include recipients of services provided through other
24	24	benefits programs administered by the commission or a health and
25	25	human services agency.
26	26	SECTION 2. Section 32.0421(a), Human Resources Code, is
27	27	amended to read as follows:
28	28	(a) The commission may impose an administrative penalty on a
29	29	person who does not comply with a request for information made under
30	30	Section 32.0424(a) [32.042(b)].
31	31	SECTION 3. Section 32.0424, Human Resources Code, is
32	32	amended to read as follows:
33	33	Sec. 32.0424. REQUIREMENTS OF THIRD-PARTY HEALTH INSURERS.
34	34	(a) A third-party health insurer shall [is required to] provide to
35	35	the commission or the commission's designee, on the commission's or
36	36	the commission's designee's request, information in a form
37	37	prescribed by the executive commissioner necessary to determine:
38	38	(1) the period during which an individual entitled to
39	39	medical assistance, the individual's spouse, or the individual's
40	40	dependents may be, or may have been, covered by coverage issued by
41	41	the health insurer;
42	42	(2) the nature of the coverage; and
43	43	(3) the name, address, and identifying number of the
44	44	health plan under which the person may be, or may have been,
45	45	covered.
46	46	(b) A third-party health insurer shall accept the state's
47	47	right of recovery and the assignment under Section 32.033 to the
48	48	state of any right of an individual or other entity to payment from
49	49	the third-party health insurer for an item or service for which
50	50	payment was made under the medical assistance program, including a
51	51	waiver program established under the medical assistance program.
52	52	(b-1) Except as provided by Subsection (b-2), for an item or
53	53	service provided to an individual entitled to medical assistance
54	54	that was previously paid for by the commission or the commission's
55	55	designee and for which a third-party health insurer is responsible
56	56	for payment, the third-party health insurer shall accept
57	57	authorization provided by the commission or the commission's
58	58	designee that the item or service is covered under the medical
59	59	assistance program as if that authorization is a prior
60	60	authorization made by the third-party health insurer for the item
61	61	or service.
62	62	(b-2) Subsection (b-1) does not apply to a third-party
63	63	health insurer with respect to providing:
64	64	(1) hospital insurance benefits or supplementary
65	65	insurance benefits under Part A or B of Title XVIII of the Social
66	66	Security Act (42 U.S.C. Section 1395c et seq. or 1395j et seq.);
67	67	(2) a health care prepayment plan under Section
68	68	1833(a)(1)(A), Social Security Act (42 U.S.C. Section
69	69	1395l(a)(1)(A));
70	70	(3) a Medicare Advantage plan under Part C of Title
71	71	XVIII of the Social Security Act (42 U.S.C. Section 1395w-21 et
72	72	seq.);
73	73	(4) a prescription drug plan as a prescription drug
74	74	plan sponsor under Part D of Title XVIII of the Social Security Act
75	75	(42 U.S.C. Section 1395w-101 et seq.); or
76	76	(5) a reasonable cost reimbursement plan under Section
77	77	1876, Social Security Act (42 U.S.C. Section 1395mm).
78	78	(c) Not later than the 60th day after the date a [A]
79	79	third-party health insurer receives an [shall respond to any]
80	80	inquiry from [by] the commission or the commission's designee
81	81	regarding a claim for payment for any health care item or service
82	82	submitted to the insurer [reimbursed by the commission under the
83	83	medical assistance program] not later than the third year after
84	84	[anniversary of] the date the health care item or service was
85	85	provided, the insurer shall respond to the inquiry.
86	86	(d) A third-party health insurer may not deny a claim
87	87	submitted by the commission or the commission's designee for which
88	88	payment was made under the medical assistance program solely on the
89	89	basis of the date of submission of the claim, the type or format of
90	90	the claim form, [or] a failure to present proper documentation at
91	91	the point of service that is the basis of the claim, or, for a
92	92	responsible third-party health insurer, other than an insurer
93	93	described by Subsection (b-2), a failure to obtain prior
94	94	authorization for the item or service for which the claim is being
95	95	submitted, if:
96	96	(1) the claim is submitted by the commission or the
97	97	commission's designee not later than the third anniversary of the
98	98	date the item or service was provided; and
99	99	(2) any action by the commission or the commission's
100	100	designee to enforce the state's rights with respect to the claim is
101	101	commenced not later than the sixth anniversary of the date the
102	102	commission or the commission's designee submits the claim.
103	103	(e) In this section, "third-party health insurer" means a
104	104	health insurer or other person or arrangement that is legally
105	105	responsible by state or federal law or private agreement to pay some
106	106	or all claims for health care items or services provided to an
107	107	individual. The term includes:
108	108	(1) a self-insured plan;
109	109	(2) a group health plan as defined by Section 607 of
110	110	the Employee Retirement Income Security Act of 1974 (29 U.S.C.
111	111	Section 1167);
112	112	(3) a service benefit plan;
113	113	(4) a managed care organization; and
114	114	(5) a pharmacy benefit manager [This section does not
115	115	limit the scope or amount of information required by Section
116	116	32.042].
117	117	SECTION 4. Section 32.042, Human Resources Code, is
118	118	repealed.
119	119	SECTION 5. If before implementing any provision of this Act
120	120	a state agency determines that a waiver or authorization from a
121	121	federal agency is necessary for implementation of that provision,
122	122	the agency affected by the provision shall request the waiver or
123	123	authorization and may delay implementing that provision until the
124	124	waiver or authorization is granted.
125	125	SECTION 6. This Act takes effect September 1, 2023.
126	126	______________________________ ______________________________
127	127	President of the Senate Speaker of the House
128	128	I hereby certify that S.B. No. 1342 passed the Senate on
129	129	May 10, 2023, by the following vote: Yeas 30, Nays 0.
130	130	______________________________
131	131	Secretary of the Senate
132	132	I hereby certify that S.B. No. 1342 passed the House on
133	133	May 24, 2023, by the following vote: Yeas 132, Nays 6, one
134	134	present not voting.
135	135	______________________________
136	136	Chief Clerk of the House
137	137	Approved:
138	138	______________________________
139	139	Date
140	140	______________________________
141	141	Governor