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A BILL TO BE ENTITLED
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AN ACT
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relating to Medicare provider certification and enrollment |
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prerequisites to Medicaid and child health plan program provider |
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enrollment. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter D, Chapter 532, Government Code, as |
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effective April 1, 2025, is amended by adding Section 532.0159 to |
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read as follows: |
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Sec. 532.0159. MEDICARE PROVIDER CERTIFICATION OR |
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ENROLLMENT AS PREREQUISITE TO MEDICAID PROVIDER ENROLLMENT. (a) |
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This section applies only to a provider that has not been terminated |
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or excluded from participating as a provider under Medicare, |
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another state's Medicaid program, or the child health plan program. |
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(b) To participate as a provider in Medicaid, a provider |
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must be certified for enrollment or enrolled as a provider in |
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Medicare unless the provider is exempted as provided by Subsection |
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(c). |
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(c) A provider is exempt from the Medicare certification or |
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enrollment requirement under Subsection (b) if: |
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(1) the provider's type of practice or health care |
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services offered are not covered by Medicare; |
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(2) the provider's exclusion from Medicaid |
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participation on the basis of the lack of Medicare certification or |
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enrollment will restrict a recipient's access to necessary |
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services; or |
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(3) a commission or other state agency rule expressly |
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exempts the provider from the Medicare certification or enrollment |
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requirement. |
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SECTION 2. Subchapter D, Chapter 62, Health and Safety |
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Code, is amended by adding Section 62.1562 to read as follows: |
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Sec. 62.1562. MEDICARE PROVIDER CERTIFICATION OR |
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ENROLLMENT AS PREREQUISITE TO CHILD HEALTH PLAN PROGRAM HEALTH CARE |
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PROVIDER ENROLLMENT. (a) This section applies only to a health |
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care provider that has not been terminated or excluded from |
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participating as a provider under Medicare or this state's or |
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another state's Medicaid program. |
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(b) To participate as a health care provider in the child |
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health plan program, a health care provider must be certified for |
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enrollment or enrolled as a provider in Medicare unless the |
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provider is exempted as provided by Subsection (c). |
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(c) A health care provider is exempt from the Medicare |
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provider certification or enrollment requirement under Subsection |
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(b) if: |
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(1) the provider's type of practice or health care |
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services offered are not covered by Medicare; |
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(2) the provider's exclusion from child health plan |
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program participation on the basis of the lack of Medicare |
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certification or enrollment will restrict an enrollee's access to |
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necessary health care services; or |
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(3) a commission or other state agency rule expressly |
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exempts the provider from the Medicare certification or enrollment |
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requirement. |
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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 4. This Act takes effect September 1, 2025. |