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A BILL TO BE ENTITLED
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AN ACT
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relating to administrative and judicial review of certain Medicaid |
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reimbursement disputes. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter B, Chapter 531, Government Code, is |
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amended by adding Subsection 531.02115 to read as follows: |
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Sec. 531.02115. ADMINISTRATIVE AND JUDICIAL REVIEW OF |
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REIMBURSEMENT DISPUTES UNDER MEDICAID PROGRAM. (a) A provider has |
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the right to a contested case hearing to dispute the amount of a |
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reimbursement rate paid to the provider under the fee-for-service |
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Medicaid program or by a managed care organization under the |
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managed care Medicaid program if the provider maintains that the |
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rate is below the rate necessary to recover the provider's |
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reasonable operating expenses and to realize a reasonable return on |
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the provider's investments that is sufficient to ensure confidence |
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in the provider's continued financial integrity. |
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(b) A contested case hearing under this section must be |
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conducted by a hearing officer in the manner provided for contested |
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case hearings under Subchapter C, Chapter 2001. |
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(c) Parties to a contested case hearing under this section |
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must include: |
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(1) the commission; and |
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(2) in a dispute involving a payment made by a managed |
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care organization, the managed care organization. |
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(d) Exhaustion of contractual remedies with a managed care |
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organization or its agent is not a prerequisite to a contested case |
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hearing under this section. |
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(e) In the absence of a timely appeal for judicial review |
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under Subsection (f), the decision of a hearing officer under this |
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section is final. |
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(f) Judicial review of a decision or order of a hearing |
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officer is governed by Subchapter G, Chapter 2001, except that the |
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party seeking judicial review must file suit not later than the 45th |
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day after the date notice of the decision made by the hearing |
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officer was mailed. |
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SECTION 2. The change in law made by this Act applies only |
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to a reimbursement paid to a Medicaid provider on or after the |
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effective date of this Act. |
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SECTION 3. 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 4. 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, 2013. |