By Harris S.B. No. 534
Substitute the following for S.B. No. 534:
By Maxey C.S.S.B. No. 534
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the collection of claims for recovery of money under
1-3 subrogation and third-party reimbursement rights arising from
1-4 medical payments by health and human services agencies.
1-5 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-6 SECTION 1. Subchapter B, Chapter 531, Government Code, is
1-7 amended by adding Sections 531.0391 and 531.0392 to read as
1-8 follows:
1-9 Sec. 531.0391. SUBROGATION AND THIRD-PARTY REIMBURSEMENT
1-10 COLLECTION CONTRACT. (a) The commission shall enter into a
1-11 contract under which the contractor is authorized on behalf of the
1-12 commission or a health and human services agency to recover money
1-13 under a subrogation or third-party reimbursement right held by the
1-14 commission or a health and human services agency arising from
1-15 payment of medical expenses. The contract must provide that:
1-16 (1) the commission or agency, as appropriate, shall
1-17 compensate the contractor based on a percentage of the amount of
1-18 money recovered by the contractor for the commission or agency; and
1-19 (2) with the approval of the attorney required by
1-20 other law to represent the commission or agency in court, the
1-21 contractor may represent the commission or agency in a court
1-22 proceeding to recover money under a subrogation or third-party
1-23 reimbursement right if the representation is cost-effective and
1-24 specifically authorized by the commission.
2-1 (b) The commission shall develop a process for identifying
2-2 claims for the recovery of money under a subrogation or third-party
2-3 reimbursement right described by this section and referring the
2-4 claims to the contractor. A health and human services agency shall
2-5 cooperate with the contractor on a claim of the agency referred to
2-6 the contractor for collection.
2-7 (c) The commission is not required to enter into a contract
2-8 under Subsection (a) if the commission cannot identify a contractor
2-9 who is willing to contract with the commission on reasonable terms.
2-10 If the commission cannot identify such a contractor, the commission
2-11 shall develop and implement alternative policies to ensure the
2-12 collection of money under a subrogation or third-party
2-13 reimbursement right.
2-14 (d) The commission may allow a state agency other than a
2-15 health and human services agency to be a party to the contract
2-16 required under Subsection (a). In that case, the commission shall
2-17 modify the contract as necessary to reflect the services to be
2-18 provided by the contractor to the additional state agency.
2-19 Sec. 531.0392. SUBROGATION AND THIRD-PARTY REIMBURSEMENT;
2-20 HOSPITAL PROVIDERS. A hospital provider may recover from a third
2-21 party any funds to which the commission or a health and human
2-22 services agency has a right of recovery under Section 32.033, Human
2-23 Resources Code. In addition, a hospital provider may file a lien
2-24 under Chapter 55, Property Code, to recover the full amount of
2-25 hospital charges for services provided to a recipient of medical
2-26 assistance under Chapter 32, Human Resources Code. On recovery
2-27 from a third party, the hospital provider shall reimburse the
3-1 commission or a health and human services agency for any amount
3-2 previously paid to the hospital provider by the commission or the
3-3 health and human services agency, as appropriate. The combined
3-4 amounts received by the hospital provider from the commission or a
3-5 health and human services agency and the third party may not exceed
3-6 the amount charged by the hospital for the injured recipient's
3-7 first 100 days of hospitalization.
3-8 SECTION 2. Not later than February 1, 1998, the Health and
3-9 Human Services Commission shall enter into an initial contract or
3-10 implement the alternative policies as required by Section 531.0391,
3-11 Government Code, as added by this Act.
3-12 SECTION 3. Not later than September 1, 1998, the Health and
3-13 Human Services Commission shall prepare and deliver to the
3-14 governor, lieutenant governor, speaker of the house of
3-15 representatives, and clerks of the standing committees of the
3-16 senate and house of representatives with primary jurisdiction over
3-17 human services a report concerning:
3-18 (1) the commission's progress in improving collection
3-19 of money under subrogation and third-party reimbursement rights
3-20 relating to medical expenses paid by the commission and health and
3-21 human services agencies;
3-22 (2) the adequacy of existing lien and subrogation
3-23 statutes;
3-24 (3) any feature of a contract or a claims processing
3-25 procedure of the commission or a health and human services agency
3-26 that limits the ability of the commission or agency to collect
3-27 money under a subrogation or third-party reimbursement right
4-1 described by Subdivision (1) of this section; and
4-2 (4) any other matter affecting the ability of the
4-3 commission or a health and human services agency to collect money
4-4 under a subrogation or third-party reimbursement right described by
4-5 Subdivision (1) of this section.
4-6 SECTION 4. The importance of this legislation and the
4-7 crowded condition of the calendars in both houses create an
4-8 emergency and an imperative public necessity that the
4-9 constitutional rule requiring bills to be read on three several
4-10 days in each house be suspended, and this rule is hereby suspended,
4-11 and that this Act take effect and be in force from and after its
4-12 passage, and it is so enacted.