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A BILL TO BE ENTITLED
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AN ACT
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relating to the enrollment of health care providers in Medicaid. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 531.02118, Government Code, is amended |
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by amending Subsection (c) and adding Subsections (e), (f), (g), |
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(h), and (i) to read as follows: |
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(c) In streamlining the Medicaid provider credentialing |
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process under this section, the commission may designate a |
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centralized credentialing entity and shall require [may]: |
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(1) that the credentialing entity and the entity |
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serving as the state's Medicaid claims administrator share |
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information to reduce the submission of duplicative information or |
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documents necessary for both Medicaid enrollment and credentialing |
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[in the database established under Subchapter C, Chapter 32, Human
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Resources Code, with the centralized credentialing entity]; and |
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(2) [require] all managed care organizations |
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contracting with the commission to provide health care services to |
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Medicaid recipients under a managed care plan issued by the |
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organization to use the centralized credentialing entity as a hub |
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for the collection and sharing of information. |
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(e) Subject to Subsection (f), the commission shall enroll a |
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provider as a Medicaid provider, without requiring the provider to |
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separately apply for enrollment through the entity serving as the |
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state's Medicaid claims administrator, if the provider is: |
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(1) credentialed by a managed care organization that |
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contracts with the commission under Chapter 533; or |
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(2) enrolled as a Medicare provider. |
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(f) The executive commissioner by rule may establish |
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additional enrollment requirements that are: |
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(1) necessary to enroll a provider as a Medicaid |
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provider; and |
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(2) not otherwise required by managed care |
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organization credentialing or Medicare provider enrollment. |
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(g) The commission shall track the number of providers that |
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enroll as Medicaid providers through each type of enrollment |
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process described by Subsection (e), including the enrollment |
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process through the entity serving as the state's Medicaid claims |
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administrator. |
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(h) The commission shall develop a process to streamline the |
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Medicaid enrollment of a provider who: |
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(1) provides services through a single case agreement |
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to a recipient who is also enrolled in a private group health |
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benefit plan; and |
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(2) is enrolled as a provider in that group health |
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benefit plan. |
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(i) The commission shall use a provider's national provider |
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identifier number to enroll a provider under Subsection (h). In |
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this subsection, "national provider identifier number" means the |
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national provider identifier number required under Section |
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1128J(e), Social Security Act (42 U.S.C. Section 1320a-7k(e)). |
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SECTION 2. 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 3. The Health and Human Services Commission is |
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required to implement a provision of this Act only if the |
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legislature appropriates money specifically for that purpose. If |
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the legislature does not appropriate money specifically for that |
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purpose, the commission may, but is not required to, implement a |
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provision of this Act using other appropriations available for that |
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purpose. |
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SECTION 4. This Act takes effect September 1, 2019. |