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A BILL TO BE ENTITLED
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AN ACT
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relating to prior authorization procedures for physical therapy |
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services in Medicaid and the child health plan program. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter B, Chapter 531, Government Code, is |
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amended by adding Section 531.0755 to read as follows: |
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Sec. 531.0755. PRIOR AUTHORIZATION PROCEDURES FOR PHYSICAL |
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THERAPY SERVICES. (a) The commission shall standardize prior |
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authorization request procedures for physical therapy services in |
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Medicaid and the child health plan program by: |
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(1) developing a standard prior authorization request |
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form for use in both fee-for-service and managed care delivery |
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models; |
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(2) requiring a provider to submit a prior |
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authorization request to the entity serving as the state's Medicaid |
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claims administrator using the standard prior authorization |
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request form; |
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(3) requiring the entity serving as the state's |
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Medicaid claims administrator to make a determination regarding the |
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prior authorization; and |
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(4) if applicable, requiring the entity serving as the |
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state's Medicaid claims administrator to forward for processing the |
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prior authorization request and the determination to the managed |
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care organization with which the Medicaid recipient or child health |
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plan program enrollee is enrolled. |
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(b) A managed care organization with which a Medicaid |
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recipient or child health plan program enrollee is enrolled may not |
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require a provider or the recipient or enrollee to use any prior |
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authorization request procedure for physical therapy services |
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other than the procedure under Subsection (a). |
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SECTION 2. Not later than December 1, 2019, the Health and |
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Human Services Commission shall develop the standard prior |
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authorization request form required by Section 531.0755, |
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Government Code, as added by this Act. |
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SECTION 3. This Act takes effect immediately if it receives |
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a vote of two-thirds of all the members elected to each house, as |
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provided by Section 39, Article III, Texas Constitution. If this |
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Act does not receive the vote necessary for immediate effect, this |
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Act takes effect September 1, 2019. |