| |
| |
| |
|
|
AN ACT
|
|
|
relating to the medical assistance program and to the billing |
|
|
coordination system for claims submitted for payment from the |
|
|
Medicaid program. |
|
|
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
|
|
SECTION 1. Section 531.02413, Government Code, as added by |
|
|
Chapter 268 (S.B. 10), Acts of the 80th Legislature, Regular |
|
|
Session, 2007, is amended by adding Subsection (a-1) and amending |
|
|
Subsections (b) and (c) to read as follows: |
|
|
(a-1) If cost-effective and feasible, the commission shall |
|
|
contract to expand the Medicaid billing coordination system |
|
|
described by Subsection (a) to process claims for all other health |
|
|
care services provided through the Medicaid program in the manner |
|
|
claims for acute care services are processed by the system under |
|
|
Subsection (a). This subsection does not apply to claims for health |
|
|
care services provided through the Medicaid program if, before |
|
|
September 1, 2009, those claims were being processed by an |
|
|
alternative billing coordination system. |
|
|
(b) If cost-effective, the executive commissioner shall |
|
|
adopt rules for the purpose of enabling the system described by |
|
|
Subsection (a) to identify an entity with primary responsibility |
|
|
for paying a claim that is processed by the system under Subsection |
|
|
(a) and establish reporting requirements for any entity that may |
|
|
have a contractual responsibility to pay for the types of [acute
|
|
|
care] services that are provided under the Medicaid program and the |
|
|
claims for which are processed by the system under Subsection (a). |
|
|
(c) An entity that holds a permit, license, or certificate |
|
|
of authority issued by a regulatory agency of the state must allow a |
|
|
[the] contractor under this section [Subsection (a)] access to |
|
|
databases to allow the contractor to carry out the purposes of this |
|
|
section, subject to the contractor's contract with the commission |
|
|
and rules adopted under this section, and is subject to an |
|
|
administrative penalty or other sanction as provided by the law |
|
|
applicable to the permit, license, or certificate of authority for |
|
|
a violation by the entity of a rule adopted under this section. |
|
|
SECTION 2. Section 32.024, Human Resources Code, is amended |
|
|
by adding Subsection (ii) to read as follows: |
|
|
(ii) The department shall provide medical assistance |
|
|
reimbursement to a pharmacist who is licensed to practice pharmacy |
|
|
in this state, is authorized to administer immunizations in |
|
|
accordance with rules adopted by the Texas State Board of Pharmacy, |
|
|
and administers an immunization to a recipient of medical |
|
|
assistance to the same extent the department provides reimbursement |
|
|
to a physician or other health care provider participating in the |
|
|
medical assistance program for the administration of that |
|
|
immunization. |
|
|
SECTION 3. Subchapter B, Chapter 32, Human Resources Code, |
|
|
is amended by adding Section 32.0424 to read as follows: |
|
|
Sec. 32.0424. REQUIREMENTS OF THIRD-PARTY HEALTH INSURERS. |
|
|
(a) A third-party health insurer is required to provide to the |
|
|
department, on the department's request, information in a form |
|
|
prescribed by the department necessary to determine: |
|
|
(1) the period during which an individual entitled to |
|
|
medical assistance, the individual's spouse, or the individual's |
|
|
dependents may be, or may have been, covered by coverage issued by |
|
|
the health insurer; |
|
|
(2) the nature of the coverage; and |
|
|
(3) the name, address, and identifying number of the |
|
|
health plan under which the person may be, or may have been, |
|
|
covered. |
|
|
(b) A third-party health insurer shall accept the state's |
|
|
right of recovery and the assignment under Section 32.033 to the |
|
|
state of any right of an individual or other entity to payment from |
|
|
the third-party health insurer for an item or service for which |
|
|
payment was made under the medical assistance program. |
|
|
(c) A third-party health insurer shall respond to any |
|
|
inquiry by the department regarding a claim for payment for any |
|
|
health care item or service reimbursed by the department under the |
|
|
medical assistance program not later than the third anniversary of |
|
|
the date the health care item or service was provided. |
|
|
(d) A third-party health insurer may not deny a claim |
|
|
submitted by the department or the department's designee for which |
|
|
payment was made under the medical assistance program solely on the |
|
|
basis of the date of submission of the claim, the type or format of |
|
|
the claim form, or a failure to present proper documentation at the |
|
|
point of service that is the basis of the claim, if: |
|
|
(1) the claim is submitted by the department or the |
|
|
department's designee not later than the third anniversary of the |
|
|
date the item or service was provided; and |
|
|
(2) any action by the department or the department's |
|
|
designee to enforce the state's rights with respect to the claim is |
|
|
commenced not later than the sixth anniversary of the date the |
|
|
department or the department's designee submits the claim. |
|
|
(e) This section does not limit the scope or amount of |
|
|
information required by Section 32.042. |
|
|
SECTION 4. The Health and Human Services Commission may |
|
|
seek to amend an existing contract entered into under Section |
|
|
531.02413, Government Code, as added by Chapter 268 (S.B. 10), Acts |
|
|
of the 80th Legislature, Regular Session, 2007, or may enter into a |
|
|
new contract, to implement the changes made to that section by this |
|
|
Act. |
|
|
SECTION 5. 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 6. This Act takes effect September 1, 2009. |
|
|
|
|
|
|
| |
| |
| |
| |
______________________________ |
______________________________ |
| |
President of the Senate |
Speaker of the House |
| |
|
|
I hereby certify that S.B. No. 531 passed the Senate on |
|
|
March 25, 2009, by the following vote: Yeas 31, Nays 0; and that |
|
|
the Senate concurred in House amendments on May 29, 2009, by the |
|
|
following vote: Yeas 31, Nays 0. |
|
|
|
| |
| |
______________________________ |
| |
Secretary of the Senate |
| |
|
|
I hereby certify that S.B. No. 531 passed the House, with |
|
|
amendments, on May 27, 2009, by the following vote: Yeas 147, |
|
|
Nays 1, one present not voting. |
|
|
|
| |
| |
______________________________ |
| |
Chief Clerk of the House |
| |
|
|
|
| |
|
|
Approved: |
|
|
|
|
|
______________________________ |
|
|
Date |
|
|
|
|
|
|
|
|
______________________________ |
|
|
Governor |