|
Senate Bill 8 |
Senate Author: Nelson et al. |
|
Effective: 9-1-13 |
House Sponsor: Kolkhorst et al. |
Senate Bill 8 amends provisions of the Government Code, Health and Safety Code, and Human Resources Code to address the provision and delivery of certain health and human services in Texas. The bill requires the executive commissioner of the Health and Human Services Commission (HHSC) to establish a data analysis unit designed to improve contract management, detect data trends, and identify anomalies relating to service utilization, providers, payment methodologies, and compliance with Medicaid and child health plan program provider contract requirements and prohibits those providers from engaging in marketing activity except under certain circumstances. The bill establishes requirements for HHSC to periodically review the prior authorization and utilization review processes within the Medicaid fee-for-service delivery model and to monitor Medicaid managed care organizations to ensure that the organizations are using the review processes to ensure the appropriate use of services.
Senate Bill 8 expands the responsibilities of the HHSC office of inspector general and authorizes the office to employ and commission peace officers to assist the office in investigating fraud, waste, and abuse in the Medicaid program. The bill sets out provisions for the delivery of medical transportation program services, including provisions relating to procuring managed transportation organizations to contract with certain medical transportation providers, contracting with certain transportation service area providers, and providing medical transportation program services in different areas of the state. The bill requires HHSC to enter into a memorandum of understanding with the Texas Department of Motor Vehicles and the Department of Public Safety to obtain the motor vehicle registration and driver's license information of providers of medical transportation services to confirm provider compliance with applicable requirements. The bill extends the applicability of certain contract requirements for an outpatient pharmacy benefit plan maintained by a managed care organization participating in the Medicaid managed care program until August 31, 2018.
Senate Bill 8 establishes additional licensing requirements for emergency medical services providers, including requirements to provide the Department of State Health Services (DSHS) with a letter of credit and HHSC with a surety bond and to obtain a letter of approval from the municipality or county in which the applicant will provide services. The bill establishes qualification and continuing education requirements for the administrator of record for an emergency medical services provider. The bill sets out DSHS reporting requirements relating to licensing data and activities for emergency medical services provider licenses, provides for the suspension, revocation, or denial of an emergency medical services provider license, and places a moratorium on the issuance of new licenses for the period beginning September 1, 2013, and ending August 31, 2014.
Senate Bill 8 provides for the revocation of a provider's enrollment or denial of a person's application for enrollment as a Medicaid provider if the person has been excluded or debarred from participation in a state or federally funded health care program because of certain misconduct and for the electronic exchange of certain prior authorization requests in accordance with national standards. The bill revises the date on which the ineligibility period begins for a Medicaid provider found liable for committing an unlawful act. The bill provides for the review of and solicitation of input regarding laws and policies related to the use of non-emergent services provided by ambulance providers, the licensure of nonemergency transportation providers, the delegation of health care services by physicians or medical directors to qualified emergency medical services personnel, and physicians' assessment of patients' needs for purposes of ambulatory transfer or transport or other purposes. The bill requires HHSC to study the feasibility of developing and implementing a single standard prior authorization form to be used for requesting prior authorization for prescription drugs in the Medicaid program by certain providers without electronic capabilities and requires the HHSC office of inspector general to review the manner in which the office investigates fraud, waste, and abuse in the supplemental nutrition assistance program and coordinates with other state and federal agencies in conducting those investigations.