78R355 SGA-D

By:  Chavez                                                       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.