89R4910 AND-D
By: Alvarado S.B. No. 2348
A BILL TO BE ENTITLED
AN ACT
relating to Medicare provider certification and enrollment
prerequisites to Medicaid and child health plan program provider
enrollment.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter D, Chapter 532, Government Code, as
effective April 1, 2025, is amended by adding Section 532.0159 to
read as follows:
Sec. 532.0159. MEDICARE PROVIDER CERTIFICATION OR
ENROLLMENT AS PREREQUISITE TO MEDICAID PROVIDER ENROLLMENT. (a)
This section applies only to a provider that has not been terminated
or excluded from participating as a provider under Medicare,
another state's Medicaid program, or the child health plan program.
(b) To participate as a provider in Medicaid, a provider
must be certified for enrollment or enrolled as a provider in
Medicare unless the provider is exempted as provided by Subsection
(c).
(c) A provider is exempt from the Medicare certification or
enrollment requirement under Subsection (b) if:
(1) the provider's type of practice or health care
services offered are not covered by Medicare;
(2) the provider's exclusion from Medicaid
participation on the basis of the lack of Medicare certification or
enrollment will restrict a recipient's access to necessary
services; or
(3) a commission or other state agency rule expressly
exempts the provider from the Medicare certification or enrollment
requirement.
SECTION 2. Subchapter D, Chapter 62, Health and Safety
Code, is amended by adding Section 62.1562 to read as follows:
Sec. 62.1562. MEDICARE PROVIDER CERTIFICATION OR
ENROLLMENT AS PREREQUISITE TO CHILD HEALTH PLAN PROGRAM HEALTH CARE
PROVIDER ENROLLMENT. (a) This section applies only to a health
care provider that has not been terminated or excluded from
participating as a provider under Medicare or this state's or
another state's Medicaid program.
(b) To participate as a health care provider in the child
health plan program, a health care provider must be certified for
enrollment or enrolled as a provider in Medicare unless the
provider is exempted as provided by Subsection (c).
(c) A health care provider is exempt from the Medicare
provider certification or enrollment requirement under Subsection
(b) if:
(1) the provider's type of practice or health care
services offered are not covered by Medicare;
(2) the provider's exclusion from child health plan
program participation on the basis of the lack of Medicare
certification or enrollment will restrict an enrollee's access to
necessary health care services; or
(3) a commission or other state agency rule expressly
exempts the provider from the Medicare certification or enrollment
requirement.
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 4. This Act takes effect September 1, 2025.