83R6742 JSL-D

By: Guerra H.B. No. 3712

A BILL TO BE ENTITLED

AN ACT

relating to a provider protection plan that ensures efficiency and reduces administrative burdens on providers participating in a Medicaid managed care model or arrangement.

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

SECTION 1. Subchapter A, Chapter 533, Government Code, is amended by adding Section 533.0055 to read as follows:

Sec. 533.0055. PROVIDER PROTECTION PLAN. (a) The commission shall develop and implement a provider protection plan that is designed to reduce administrative burdens placed on providers participating in a Medicaid managed care model or arrangement implemented under this chapter and ensure efficiency in provider enrollment and reimbursement. The commission shall incorporate the measures identified in the plan, to the greatest extent possible, into each contract between a managed care organization and the commission for the provision of health care services to recipients.

(b) The provider protection plan required under this section must provide for:

(1) prompt payment and proper reimbursement of providers by managed care organizations;

(2) the assessment of penalties against managed care organizations for failing to properly pay provider claims, including instances of nonpayment and consistent shortage of payment;

(3) adequate and clearly defined provider network standards;

(4) a prompt credentialing process for providers;

(5) the use of an Internet portal system for prior authorization requests and electronic claim submission;

(6) a requirement that a managed care organization maintain an office within the area served by the organization; and

(7) any other provision that the commission determines will ensure efficiency or reduce administrative burdens on providers participating in a Medicaid managed care model or arrangement.

SECTION 2. As soon as possible, but not later than September 1, 2014, the Health and Human Services Commission shall implement the provider protection plan required under Section 533.0055, Government Code, as added by 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 September 1, 2013.