83R10419 ADM-F
 
  By: Eiland H.B. No. 3452
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to administrative and judicial review of certain Medicaid
  reimbursement disputes.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Subchapter B, Chapter 531, Government Code, is
  amended by adding Subsection 531.02115 to read as follows:
         Sec. 531.02115.  ADMINISTRATIVE AND JUDICIAL REVIEW OF
  REIMBURSEMENT DISPUTES UNDER MEDICAID PROGRAM. (a) A provider has
  the right to a contested case hearing to dispute the amount of a
  reimbursement rate paid to the provider under the fee-for-service
  Medicaid program or by a managed care organization under the
  managed care Medicaid program if the provider maintains that the
  rate is below the rate necessary to recover the provider's
  reasonable operating expenses and to realize a reasonable return on
  the provider's investments that is sufficient to ensure confidence
  in the provider's continued financial integrity.
         (b)  A contested case hearing under this section must be
  conducted by a hearing officer in the manner provided for contested
  case hearings under Subchapter C, Chapter 2001.
         (c)  Parties to a contested case hearing under this section
  must include:
               (1)  the commission; and
               (2)  in a dispute involving a payment made by a managed
  care organization, the managed care organization.
         (d)  Exhaustion of contractual remedies with a managed care
  organization or its agent is not a prerequisite to a contested case
  hearing under this section.
         (e)  In the absence of a timely appeal for judicial review
  under Subsection (f), the decision of a hearing officer under this
  section is final.
         (f)  Judicial review of a decision or order of a hearing
  officer is governed by Subchapter G, Chapter 2001, except that the
  party seeking judicial review must file suit not later than the 45th
  day after the date notice of the decision made by the hearing
  officer was mailed.
         SECTION 2.  The change in law made by this Act applies only
  to a reimbursement paid to a Medicaid provider on or after the
  effective date of this Act.
         SECTION 3.  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 4.  This Act takes effect immediately if it receives
  a vote of two-thirds of all the members elected to each house, as
  provided by Section 39, Article III, Texas Constitution.  If this
  Act does not receive the vote necessary for immediate effect, this
  Act takes effect September 1, 2013.