BILL ANALYSIS

Senate Research Center	S.B. 2086
86R8048 JG-D	By: Hinojosa
	Health & Human Services
	4/4/2019
	As Filed

AUTHOR'S / SPONSOR'S STATEMENT OF INTENT

The Government Code currently has multiple references to required electronic portals that Medicaid providers should be able to access in order to accomplish a number of claims-related tasks that they must routinely do. Many suggest that by combining these portals into a single state-run portal, providers of Medicaid services would more efficiently be able to accomplish their administrative tasks than in the current environment.

S.B. 2086 would require the Health and Human Services Commission (HHSC) to consolidate certain electronic or Internet portals to streamline billing and claims processes. HHSC would in turn require managed care organizations to allow providers to use the consolidated portal.

As proposed, S.B. 2086 amends current law relating to a single Internet portal through which Medicaid providers may submit and receive information.

RULEMAKING AUTHORITY

Rulemaking authority is expressly granted to executive commissioner of the Health and Human Services Commission in SECTION 1 (Section 533.0055, Government Code) of this bill.

SECTION BY SECTION ANALYSIS

SECTION 1. Amends Section 533.0055, Government Code, by amending Subsection (b) and adding Subsections (c), (d), and (e), as follows:

(b) Requires the provider protection plan required under this section (Provider Protection Plan) to provide for:

(1)�(5) makes no change to these subdivisions;

(6) establishment and maintenance of an Internet portal, rather than establishment of an electronic process including the use of an Internet portal, through which providers in any managed care organization's provider network may perform certain tasks.

(7) makes no changes to this subdivision;

(8) the creation of a work group to review and make recommendations to the Health and Human Services Commission (HHSC) concerning any requirement under this subsection for which immediate implementation is not feasible at the time the plan is otherwise implemented, including the required process for submission and acceptance of attachments for claims processing and prior authorization requests through the Internet portal required by, rather than through an electronic process under, Subdivision (6) and, for any requirement that is not implemented immediately, recommendations regarding certain information; and

(9) makes no changes to this subdivision.

(c) Requires HHSC to consolidate each electronic or Internet portal operated or maintained by HHSC, including through a contract with a separate entity, that is used to receive and deliver requests and other information from and to Medicaid providers, including nursing facility providers participating in the STAR+PLUS Medicaid managed care program, into the single Internet portal required by Subsection (b)(6). Requires HHSC to ensure the single Internet portal meets the requirements of a portal described by Sections 531.02411 (Streamlining Administrative Processes), 533.00251 (Delivery of Certain Benefits, Including Nursing Facility Benefits, Through STAR+PLUS Medicaid Managed Care Program), 533.002553 (Behavioral Health Services Provided Through Third Party or Subsidiary), and 533.0071 (Administration of Contracts).

(d) Authorizes HHSC to contract with a private or nonprofit entity to develop, operate, and maintain the single Internet portal required by Subsection (b)(6). Prohibits the entity from being affiliated with any specific managed care plan.

(e) Requires the executive commissioner of HHSC by rule to require each managed care organization to allow providers in the organization's provider network to use the single Internet portal required by Subsection (b)(6).

SECTION 2. Requires HHSC, not later than January 1, 2021, or an entity with whom HHSC contracts, to develop and implement the single Internet portal required by Section 533.0055, Government Code, as amended by this Act.

SECTION 3. Effective date: September 1, 2019.