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                                  * * * * *