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A BILL TO BE ENTITLED
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AN ACT
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relating to reimbursement for health care services provided at |
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certain times to persons enrolled in the Medicaid managed care |
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program. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter A, Chapter 533, Government Code, is |
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amended by adding Section 533.01315 to read as follows: |
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Sec. 533.01315. REIMBURSEMENT FOR SERVICES PROVIDED OUTSIDE |
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OF REGULAR BUSINESS HOURS. (a) This section applies only to a |
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recipient receiving medical assistance through any Medicaid |
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managed care model or arrangement. |
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(b) The commission shall ensure that a federally qualified |
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health center, rural health clinic, or municipal health |
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department's public clinic is reimbursed for health care services |
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provided to a recipient outside of regular business hours, |
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including on a weekend or holiday, at a rate that is equal to the |
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allowable rate for those services as determined under Section |
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32.028, Human Resources Code, regardless of whether the recipient |
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has a referral from the recipient's primary care provider. |
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(c) The executive commissioner shall adopt rules regarding |
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the days, times of days, and holidays that are considered to be |
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outside of regular business hours for purposes of Subsection (b). |
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SECTION 2. If before implementing any provision of this |
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Act a state agency determines that a waiver or authorization from a |
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federal agency is necessary for implementation of that provision, |
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the agency affected by the provision shall request the waiver or |
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authorization and may delay implementing that provision until the |
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waiver or authorization is granted. |
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SECTION 3. This Act takes effect September 1, 2007. |