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A BILL TO BE ENTITLED
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AN ACT
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relating to a provider protection plan that ensures efficiency and |
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reduces administrative burdens on providers participating in a |
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Medicaid managed care model or arrangement. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter A, Chapter 533, Government Code, is |
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amended by adding Section 533.0055 to read as follows: |
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Sec. 533.0055. PROVIDER PROTECTION PLAN. (a) The |
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commission shall develop and implement a provider protection plan |
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that is designed to reduce administrative burdens placed on |
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providers participating in a Medicaid managed care model or |
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arrangement implemented under this chapter and ensure efficiency in |
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provider enrollment and reimbursement. The commission shall |
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incorporate the measures identified in the plan, to the greatest |
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extent possible, into each contract between a managed care |
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organization and the commission for the provision of health care |
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services to recipients. |
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(b) The provider protection plan required under this |
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section must provide for: |
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(1) prompt payment and proper reimbursement of |
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providers by managed care organizations; |
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(2) the assessment of penalties against managed care |
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organizations for failing to properly pay provider claims, |
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including instances of nonpayment and consistent shortage of |
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payment; |
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(3) adequate and clearly defined provider network |
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standards; |
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(4) a prompt credentialing process for providers; |
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(5) the use of an Internet portal system for prior |
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authorization requests and electronic claim submission; |
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(6) a requirement that a managed care organization |
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maintain an office within the area served by the organization; and |
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(7) any other provision that the commission determines |
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will ensure efficiency or reduce administrative burdens on |
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providers participating in a Medicaid managed care model or |
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arrangement. |
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SECTION 2. As soon as possible, but not later than September |
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1, 2014, the Health and Human Services Commission shall implement |
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the provider protection plan required under Section 533.0055, |
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Government Code, as added by 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 September 1, 2013. |