1-1 By: Maxey (Senate Sponsor - Zaffirini) H.B. No. 867
1-2 (In the Senate - Received from the House May 1, 1995;
1-3 May 2, 1995, read first time and referred to Committee on Health
1-4 and Human Services; May 10, 1995, reported favorably by the
1-5 following vote: Yeas 8, Nays 0; May 10, 1995, sent to printer.)
1-6 A BILL TO BE ENTITLED
1-7 AN ACT
1-8 relating to an automated system for providing reimbursements to
1-9 nursing homes under the state Medicaid program.
1-10 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-11 SECTION 1. Chapter 242, Health and Safety Code, is amended
1-12 by adding Subchapter H to read as follows:
1-13 SUBCHAPTER H. AUTOMATED MEDICAID PATIENT CARE
1-14 AND REIMBURSEMENT SYSTEM
1-15 Sec. 242.201. AUTOMATED SYSTEM FOR MEDICAID PATIENT CARE AND
1-16 REIMBURSEMENT. (a) The department shall acquire and develop an
1-17 automated system for providing reimbursements to nursing homes
1-18 under the state Medicaid program, subject to the availability of
1-19 funds appropriated for that purpose.
1-20 (b) The department shall select an automated system that
1-21 will allow the addition of other components of the state Medicaid
1-22 program, including components administered by other state agencies.
1-23 (c) The department and the Health and Human Services
1-24 Commission shall work together to apply for all available federal
1-25 funds to help pay for the automated system.
1-26 (d) To the extent possible, the department shall assist
1-27 nursing homes to make systems compatible with the automated system
1-28 selected by the department.
1-29 Sec. 242.202. DATA USED BY SYSTEM. The automated patient
1-30 care and reimbursement system must use a form designed by the
1-31 United States Health Care Financing Administration for nursing home
1-32 use.
1-33 Sec. 242.203. ELECTRONIC CLAIMS FOR REIMBURSEMENT. (a) The
1-34 automated reimbursement system must be able to link the department
1-35 electronically with nursing homes making claims for reimbursement.
1-36 When the system is operational, each nursing home shall make claims
1-37 electronically.
1-38 (b) The department shall charge a fee to nursing homes that
1-39 do not make their claims for reimbursement electronically. The
1-40 department shall set the fee in an amount necessary to cover the
1-41 costs of manually processing the claims.
1-42 Sec. 242.204. DATE OF REIMBURSEMENT. The department shall
1-43 pay nursing home reimbursement claims under the state Medicaid
1-44 program that are made electronically not later than the 30th day
1-45 after the date the claim is made.
1-46 Sec. 242.205. RULES. The department shall adopt rules and
1-47 make policy changes as necessary to improve the efficiency of the
1-48 reimbursement process and to maximize the automated reimbursement
1-49 system's capabilities.
1-50 SECTION 2. (a) The Texas Department of Human Services shall
1-51 implement the nursing home reimbursement component of the automated
1-52 reimbursement system required under Subchapter H, Chapter 242,
1-53 Health and Safety Code, as added by this Act, not later than
1-54 January 1, 1997. The Health and Human Services Commission shall
1-55 evaluate and determine deadlines for using the system for other
1-56 components of the state Medicaid program and shall work with health
1-57 and human services agencies to allocate costs.
1-58 (b) The department shall reduce staff and purchases as
1-59 savings and efficiency from implementing the automated
1-60 reimbursement system are realized.
1-61 SECTION 3. The importance of this legislation and the
1-62 crowded condition of the calendars in both houses create an
1-63 emergency and an imperative public necessity that the
1-64 constitutional rule requiring bills to be read on three several
1-65 days in each house be suspended, and this rule is hereby suspended,
1-66 and that this Act take effect and be in force from and after its
1-67 passage, and it is so enacted.
1-68 * * * * *