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A BILL TO BE ENTITLED
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AN ACT
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relating to the authorization of certain nonemergency ambulance |
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services under the Medicaid program. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subsection (t), Section 32.024, Human Resources |
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Code, is amended to read as follows: |
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(t) The department by rule shall require a physician, |
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nursing facility, health care provider, or other responsible party |
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to obtain authorization from the department or a person authorized |
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to act on behalf of the department on the same day or the next |
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business day following the day of transport when [before] an |
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ambulance is used to transport a recipient of medical assistance |
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under this chapter in circumstances not involving an emergency and |
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the request is for the authorization of the provision of |
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transportation for only one day. If the request is for |
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authorization of the provision of transportation on more than one |
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day, the department by rule shall require a physician, nursing |
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facility, health care provider, or other responsible party to |
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obtain a single authorization before an ambulance is used to |
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transport a recipient of medical assistance under this chapter in |
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circumstances not involving an emergency. The rules must provide |
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that: |
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(1) except as provided by Subdivision (3), a request |
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for authorization must be evaluated based on the recipient's |
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medical needs and may be granted for a length of time appropriate to |
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the recipient's medical condition; |
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(2) except as provided by Subdivision (3), a response |
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to a request for authorization must be made not later than 48 hours |
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after receipt of the request; |
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(3) a request for authorization must be immediately |
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granted and must be effective for a period of not more than 180 days |
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from the date of issuance if the request includes a written |
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statement from a physician that: |
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(A) states that alternative means of |
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transporting the recipient are contraindicated; and |
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(B) is dated not earlier than the 60th day before |
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the date on which the request for authorization is made; |
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(4) a person denied payment for ambulance services |
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rendered is entitled to payment from the nursing facility, health |
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care provider, or other responsible party that requested the |
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services if: |
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(A) payment under the medical assistance program |
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is denied because of lack of prior authorization; and |
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(B) the person provides the nursing facility, |
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health care provider, or other responsible party with a copy of the |
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bill for which payment was denied; [and] |
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(5) a person denied payment for services rendered |
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because of failure to obtain prior authorization or because a |
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request for prior authorization was denied is entitled to appeal |
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the denial of payment to the department; and |
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(6) the department or a person authorized to act on |
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behalf of the department must be available to evaluate requests for |
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authorization under this subsection not less than 12 hours each |
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day, excluding weekends and state holidays. |
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SECTION 2. If before implementing any provision of this Act |
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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 immediately if it receives |
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a vote of two-thirds of all the members elected to each house, as |
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provided by Section 39, Article III, Texas Constitution. If this |
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Act does not receive the vote necessary for immediate effect, this |
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Act takes effect September 1, 2009. |