Texas House Bill HB5512

Texas 2025 - 89th Regular

• Filed: 3/14/25

Caption

Relating to the participation and reimbursement of and requirements affecting certain providers, including providers of eye health care and vision care services, under Medicaid.

Impact

If enacted, HB5512 will bring significant changes to the Medicaid provider enrollment and credentialing procedures. The HHSC will be required to evaluate the performance of the support team and annually publish a report on its effectiveness. Additionally, it specifies conditions under which a Medicaid provider can be disenrolled, requiring a notice 30 days before disenrollment, allowing providers a chance to rectify application deficiencies. Furthermore, the bill outlines specifics on reimbursement rates for eye health care providers, ensuring that they receive a minimum amount equal to the Medicaid fee-for-service rate for similar services.

Summary

House Bill 5512 aims to enhance the participation, reimbursement processes, and requirements for providers of eye health and vision care services under Medicaid. The bill mandates the establishment of a dedicated support team by the Texas Health and Human Services Commission (HHSC). This team will assist current and prospective Medicaid providers in navigating provider enrollment and credentialing processes, thereby reducing administrative burdens. The legislation intends to improve provider engagement and ensure timely support, as well as to facilitate the submission of complaints related to the enrollment process.

Contention

Key points of contention may arise around the implementation of the bill and its potential impacts on managed care organizations and their contracts. While the bill aims to streamline processes and improve provider support, concerns could be raised about the adequacy of funding and resources to sustain the necessary changes. The requirement for managed care organizations to comply with new reimbursement guidelines may also provoke discussions on costs and the feasibility of maintaining service levels while adhering to these mandates.

Texas Constitutional Statutes Affected

Government Code

• Chapter 532. Medicaid Administration And Operation In General
  • Section: New Section

• Chapter 540. Medicaid Managed Care Program
  • Section: New Section
  • Section: 0651