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A BILL TO BE ENTITLED
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AN ACT
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relating to claims processes and reimbursement for, and overpayment |
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recoupment processes imposed on, health care providers under |
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Medicaid. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 531.1135(c), Government Code, is amended |
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to read as follows: |
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(c) Notwithstanding any other law, a managed care |
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organization may not attempt to recover an overpayment described by |
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Subsection (a) until: |
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(1) the provider has exhausted all rights to an |
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appeal; and |
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(2) the office of the inspector general has issued a |
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final determination. |
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SECTION 2. Section 531.024172(d), Government Code, is |
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amended to read as follows: |
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(d) In implementing the electronic visit verification |
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system: |
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(1) subject to Subsection (e), the executive |
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commissioner shall adopt compliance standards for health care |
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providers; and |
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(2) the commission shall ensure that: |
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(A) the information required to be reported by |
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health care providers is standardized across managed care |
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organizations that contract with the commission to provide health |
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care services to Medicaid recipients and across commission |
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programs; |
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(B) processes required by managed care |
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organizations to retrospectively correct data are standardized and |
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publicly accessible to health care providers; [and] |
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(C) standardized processes are established for |
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addressing the failure of a managed care organization to provide a |
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timely authorization for delivering services necessary to ensure |
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continuity of care; and |
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(D) a health care provider is allowed to: |
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(i) enter a variable schedule into the |
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electronic visit verification system, |
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(ii) submit a claim to be reimbursed for an |
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amount of time that is less than the verified amount of time; and |
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(iii) correct claims denied by a managed |
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care organization within 95 days of the date of denial. |
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SECTION 3. If before implementing any provision of this Act |
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a state agency determines that a waiver or authorization from a |
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federal agency is necessary for implementation of that provision, |
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the agency affected by the provision shall request the waiver or |
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authorization and may delay implementing that provision until the |
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waiver or authorization is granted. |
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SECTION 5. This Act takes effect September 1, 2021. |