By: Deuell S.B. No. 569

(In the Senate - Filed February 12, 2007; February 26, 2007, read first time and referred to Committee on Health and Human Services; April 10, 2007, reported adversely, with favorable Committee Substitute by the following vote: Yeas 9, Nays 0; April 10, 2007, sent to printer.)

COMMITTEE SUBSTITUTE FOR S.B. No. 569 By: Deuell

A BILL TO BE ENTITLED

AN ACT

relating to reimbursement for health care services provided at certain times to persons enrolled in the Medicaid managed care program.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Subchapter A, Chapter 533, Government Code, is amended by adding Section 533.01315 to read as follows:

Sec. 533.01315. REIMBURSEMENT FOR SERVICES PROVIDED OUTSIDE OF REGULAR BUSINESS HOURS. (a) This section applies only to a recipient receiving medical assistance through any Medicaid managed care model or arrangement.

(b) The commission shall ensure that a federally qualified health center, rural health clinic, or physician office or clinic is reimbursed for health care services provided to a recipient outside of regular business hours, including on a weekend or holiday, at a rate that is equal to the allowable rate for those services as determined under Section 32.028, Human Resources Code, regardless of whether the recipient has a referral from the recipient's primary care physician.

(c) The executive commissioner shall adopt rules regarding the days, times of days, and holidays that are considered to be outside of regular business hours for purposes of Subsection (b).

SECTION 2. If before implementing any provision of this Act a state agency determines that a waiver or authorization from a federal agency is necessary for implementation of that provision, the agency affected by the provision shall request the waiver or authorization and may delay implementing that provision until the waiver or authorization is granted.

SECTION 3. This Act takes effect September 1, 2007.

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