1-1 By: Maxey (Senate Sponsor - Moncrief) H.B. No. 1085
1-2 (In the Senate - Received from the House April 14, 1997;
1-3 April 16, 1997, read first time and referred to Committee on Health
1-4 and Human Services; May 7, 1997, reported favorably by the
1-5 following vote: Yeas 11, Nays 0; May 7, 1997, 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 facilities under the state Medicaid program.
1-10 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-11 SECTION 1. Subchapter H, Chapter 242, Health and Safety
1-12 Code, as added by Chapter 189, Acts of the 74th Legislature,
1-13 Regular Session, 1995, is amended to read as follows:
1-14 SUBCHAPTER I [H]. AUTOMATED MEDICAID PATIENT CARE
1-15 AND REIMBURSEMENT SYSTEM
1-16 Sec. 242.221 [242.201]. AUTOMATED SYSTEM FOR MEDICAID
1-17 PATIENT CARE AND REIMBURSEMENT. (a) The department shall acquire
1-18 and develop an automated system for providing reimbursements to
1-19 nursing facilities [homes] under the state Medicaid program,
1-20 subject to the availability of funds appropriated for that purpose.
1-21 (b) The department shall select an automated system that
1-22 will allow the addition of other components of the state Medicaid
1-23 program, including components administered by other state agencies.
1-24 (c) The department and the Health and Human Services
1-25 Commission shall work together to apply for all available federal
1-26 funds to help pay for the automated system.
1-27 (d) To the extent possible, the department shall assist
1-28 nursing facilities [homes] to make systems compatible with the
1-29 automated system selected by the department.
1-30 (e) The department shall charge a fee to nursing facilities
1-31 that do not receive their Medicaid reimbursements electronically.
1-32 The department shall set the fee in an amount necessary to cover
1-33 the costs of manually processing and sending the reimbursements.
1-34 Sec. 242.222 [242.202]. DATA USED BY SYSTEM. The automated
1-35 patient care and reimbursement system must use a form designed by
1-36 the United States Health Care Financing Administration for nursing
1-37 facility [home] use.
1-38 Sec. 242.223 [242.203]. FREQUENCY OF DATA SUBMISSION.
1-39 Nursing facilities must complete and electronically submit the
1-40 designated form to the department at least quarterly for
1-41 reimbursement.
1-42 Sec. 242.224. ELECTRONIC CLAIMS FOR REIMBURSEMENT. [(a)]
1-43 The automated reimbursement system must be able to link the
1-44 department electronically with nursing facilities [homes] making
1-45 claims for reimbursement. When the system is operational, each
1-46 nursing facility [home] shall make claims electronically.
1-47 [(b) The department shall charge a fee to nursing homes that
1-48 do not make their claims for reimbursement electronically. The
1-49 department shall set the fee in an amount necessary to cover the
1-50 costs of manually processing the claims.]
1-51 Sec. 242.225 [242.204]. DATE OF REIMBURSEMENT. The
1-52 department shall pay Medicaid nursing facility [home] reimbursement
1-53 claims [under the state Medicaid program] that are made
1-54 electronically not later than the 30th day after the date the claim
1-55 is made.
1-56 Sec. 242.226 [242.205]. RULES. The department shall adopt
1-57 rules and make policy changes as necessary to improve the
1-58 efficiency of the reimbursement process and to maximize the
1-59 automated reimbursement system's capabilities.
1-60 SECTION 2. This Act takes effect September 1, 1997.
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
2-1 days in each house be suspended, and this rule is hereby suspended.
2-2 * * * * *