H.B. 111 78(R)    BILL ANALYSIS


H.B. 111
By: Chavez
Human Services
Committee Report (Unamended)



BACKGROUND AND PURPOSE 

Medicaid health care providers are required under the Medicaid program to
provide and arrange nonemergency transportation for their severely
disabled Medicaid patients.  This requirement includes obtaining prior
authorization from the Health and Human Services Commission before
contacting the ambulance provider for transportation.  Currently, the
medical assistance program can deny payment to the ambulance service
provider if prior authorization is not received by the health care
provider.  House Bill 111 holds health care providers financially
responsible if the ambulance service provider is denied payment because
the health care provider did not receive prior authorization for the
service. 

RULEMAKING AUTHORITY

Rulemaking authority is expressly delegated to the Health and Human
Services Commission in SECTION 1 (Section 32.024(t), Human Resources Code)
of this bill. 

ANALYSIS

House Bill 111 amends the Human Resource Code by providing that a
ambulance service provider that is denied payment under Medicaid for
services rendered is entitled to payment from the health care provider if
the payment is denied due to lack of prior authorization by the health
care provider, and the ambulance service provides the health care provider
with a copy of the bill for which payment was denied.  

EFFECTIVE DATE

This Act has immediate effect if it receives a vote of two-thirds of all
members elected to each house, as provided by Section 39, Article III,
Texas Constitution. If this Act does not receive the vote necessary for
immediate effect, this Act takes effect September 1, 2003.