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.