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A BILL TO BE ENTITLED
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AN ACT
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relating to reimbursement of health care providers under Medicaid. |
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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 533.0067 to read as follows: |
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Sec. 533.0067. PROVIDER NEGOTIATIONS. The commission shall |
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establish a process to allow a health care provider who provides |
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health care services to Medicaid recipients to negotiate with a |
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managed care organization that contracts with the commission to |
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provide health care services to recipients reimbursement rates that |
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are comparable to prevailing market rates. The commission shall |
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include the process developed under this section in each contract |
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between a managed care organization and the commission in addition |
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to all other contract provisions required by this chapter. |
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SECTION 2. The heading to Section 32.029, Human Resources |
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Code, is amended to read as follows: |
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Sec. 32.029. METHODS AND TIME FOR [OF] PAYMENT. |
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SECTION 3. Section 32.029, Human Resources Code, is amended |
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by adding Subsection (f) to read as follows: |
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(f) Subject to Subsection (d), the commission shall ensure |
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that, for any claim for medical assistance payment that is received |
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with documentation reasonably necessary for the payor to process |
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the claim, payment to a provider of health care services is |
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paid not later than: |
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(1) the 45th day after the date the claim is received; |
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or |
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(2) within a period specified by a written agreement |
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between the health care provider and the payor. |
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SECTION 4. The Health and Human Services Commission shall, |
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in a contract between the commission and a managed care |
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organization under Chapter 533, Government Code, that is entered |
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into or renewed on or after the effective date of this Act, require |
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that the managed care organization comply with the process |
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established under Section 533.0067, Government Code, as added by |
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this Act. |
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SECTION 5. Section 32.029, Human Resources Code, as amended |
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by this Act, applies to a claim for payment received on or after the |
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effective date of this Act. A claim for payment received before the |
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effective date of this Act is governed by the law in effect on the |
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date the claim was received, and the former law is continued in |
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effect for that purpose. |
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SECTION 6. 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 7. This Act takes effect September 1, 2017. |