78R355 SGA-D


By:  Chavez, Wohlgemuth                                           H.B. No. 111


A BILL TO BE ENTITLED
AN ACT
relating to responsibility for payment for transport by ambulance of a recipient of medical assistance in certain circumstances. BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: SECTION 1. Section 32.024(t), Human Resources Code, is amended to read as follows: (t) The department by rule shall require a physician, nursing facility, health care provider, or other responsible party to obtain authorization from the department or a person authorized to act on behalf of the department before an ambulance is used to transport a recipient of medical assistance under this chapter in circumstances not involving an emergency. The rules must provide that: (1) except as provided by Subdivision (3), a request for authorization must be evaluated based on the recipient's medical needs and may be granted for a length of time appropriate to the recipient's medical condition; (2) except as provided by Subdivision (3), a response to a request for authorization must be made not later than 48 hours after receipt of the request; (3) a request for authorization must be immediately granted and must be effective for a period of 180 days from the date of issuance if the request includes a written statement from a physician that: (A) states that alternative means of transporting the recipient are contraindicated; and (B) is dated not earlier than the 60th day before the date on which the request for authorization is made; [and] (4) a person denied payment for ambulance services rendered is entitled to payment from the physician, nursing facility, health care provider, or other responsible party that requested the services if: (A) payment under the medical assistance program is denied because of lack of prior authorization; and (B) the person provides the physician, nursing facility, health care provider, or other responsible party with a copy of the bill for which payment was denied; and (5) a person denied payment for services rendered because of failure to obtain prior authorization or because a request for prior authorization was denied is entitled to appeal the denial of payment to the department. SECTION 2. This Act takes effect immediately if it receives a vote of two-thirds of all the 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.