By Maxey                                        H.B. No. 1085

      75R2763 KEL-D                           

                                A BILL TO BE ENTITLED

 1-1                                   AN ACT

 1-2     relating to an automated system for providing reimbursements to

 1-3     nursing facilities under the state Medicaid program.

 1-4           BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

 1-5           SECTION 1.  Subchapter H, Chapter 242, Health and Safety

 1-6     Code, as added by Chapter 189, Acts of the 74th Legislature,

 1-7     Regular Session, 1995, is amended to read as follows:

 1-8             SUBCHAPTER I [H].  AUTOMATED MEDICAID PATIENT CARE

 1-9                          AND REIMBURSEMENT SYSTEM

1-10           Sec. 242.221 [242.201].  AUTOMATED SYSTEM FOR MEDICAID

1-11     PATIENT CARE AND REIMBURSEMENT.  (a)  The department shall acquire

1-12     and develop an automated system for providing reimbursements to

1-13     nursing facilities [homes] under the state Medicaid program,

1-14     subject to the availability of funds appropriated for that purpose.

1-15           (b)  The department shall select an automated system that

1-16     will allow the addition of other components of the state Medicaid

1-17     program, including components administered by other state agencies.

1-18           (c)  The department and the Health and Human Services

1-19     Commission shall work together to apply for all available federal

1-20     funds to help pay for the automated system.

1-21           (d)  To the extent possible, the department shall assist

1-22     nursing facilities [homes] to make systems compatible with the

1-23     automated system selected by the department.

1-24           Sec. 242.222 [242.202].  DATA USED BY SYSTEM.  The automated

 2-1     patient care and reimbursement system must use a form designed by

 2-2     the United States Health Care Financing Administration for nursing

 2-3     facility [home] use.

 2-4           Sec. 242.223 [242.203].  FREQUENCY OF DATA SUBMISSION.

 2-5     Nursing facilities must complete and electronically submit the

 2-6     designated form to the department at least quarterly or more

 2-7     frequently in response to changes in resident conditions.

 2-8           Sec. 242.224.  ELECTRONIC CLAIMS FOR REIMBURSEMENT.  [(a)]

 2-9     The automated reimbursement system must be able to link the

2-10     department electronically with nursing facilities [homes] making

2-11     claims for reimbursement.  When the system is operational, each

2-12     nursing facility [home] shall make claims electronically.

2-13           [(b)  The department shall charge a fee to nursing homes that

2-14     do not make their claims for reimbursement electronically.  The

2-15     department shall set the fee in an amount necessary to cover the

2-16     costs of manually processing the claims.]

2-17           Sec. 242.225 [242.204].  DATE OF REIMBURSEMENT.  The

2-18     department shall pay Medicaid nursing facility [home] reimbursement

2-19     claims [under the state Medicaid program] that are made

2-20     electronically not later than the 30th day after the date the claim

2-21     is made.

2-22           Sec. 242.226 [242.205].  RULES.  The department shall adopt

2-23     rules and make policy changes as necessary to improve the

2-24     efficiency of the reimbursement process and to maximize the

2-25     automated reimbursement system's capabilities.

2-26           SECTION 2.  This Act takes effect September 1, 1997.

2-27           SECTION 3.  The importance of this legislation and the

 3-1     crowded condition of the calendars in both houses create an

 3-2     emergency and an imperative public necessity that the

 3-3     constitutional rule requiring bills to be read on three several

 3-4     days in each house be suspended, and this rule is hereby suspended.