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A BILL TO BE ENTITLED
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AN ACT
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relating to a single Internet portal through which Medicaid |
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providers may submit and receive information. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 533.0055, Government Code, is amended by |
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amending Subsection (b) and adding Subsections (c), (d), and (e) to |
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read as follows: |
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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) prompt and accurate adjudication of claims |
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through: |
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(A) provider education on the proper submission |
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of clean claims and on appeals; |
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(B) acceptance of uniform forms, including HCFA |
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Forms 1500 and UB-92 and subsequent versions of those forms, |
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through an electronic portal; and |
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(C) the establishment of standards for claims |
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payments in accordance with a provider's contract; |
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(3) adequate and clearly defined provider network |
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standards that are specific to provider type, including physicians, |
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general acute care facilities, and other provider types defined in |
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the commission's network adequacy standards in effect on January 1, |
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2013, and that ensure choice among multiple providers to the |
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greatest extent possible; |
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(4) a prompt credentialing process for providers; |
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(5) uniform efficiency standards and requirements for |
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managed care organizations for the submission and tracking of |
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preauthorization requests for services provided under Medicaid; |
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(6) establishment and maintenance of an [electronic
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process, including the use of an] Internet portal[,] through which |
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providers in any managed care organization's provider network may: |
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(A) submit electronic claims, prior |
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authorization requests, claims appeals and reconsiderations, |
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clinical data, and other documentation that the managed care |
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organization requests for prior authorization and claims |
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processing; and |
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(B) obtain electronic remittance advice, |
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explanation of benefits statements, and other standardized |
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reports; |
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(7) the measurement of the rates of retention by |
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managed care organizations of significant traditional providers; |
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(8) the creation of a work group to review and make |
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recommendations to the commission concerning any requirement under |
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this subsection for which immediate implementation is not feasible |
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at the time the plan is otherwise implemented, including the |
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required process for submission and acceptance of attachments for |
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claims processing and prior authorization requests through the |
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Internet portal required by [an electronic process under] |
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Subdivision (6) and, for any requirement that is not implemented |
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immediately, recommendations regarding the expected: |
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(A) fiscal impact of implementing the |
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requirement; and |
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(B) timeline for implementation of the |
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requirement; and |
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(9) 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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(c) The commission shall consolidate each electronic or |
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Internet portal operated or maintained by the commission, including |
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through a contract with a separate entity, that is used to receive |
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and deliver requests and other information from and to Medicaid |
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providers, including nursing facility providers participating in |
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the STAR+PLUS Medicaid managed care program, into the single |
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Internet portal required by Subsection (b)(6). The commission shall |
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ensure the single Internet portal meets the requirements of a |
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portal described by Sections 531.02411, 533.00251, 533.002553, and |
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533.0071. |
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(d) The commission may contract with a private or nonprofit |
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entity to develop, operate, and maintain the single Internet portal |
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required by Subsection (b)(6). The entity may not be affiliated |
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with any specific managed care plan. |
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(e) The executive commissioner by rule shall require each |
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managed care organization to allow providers in the organization's |
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provider network to use the single Internet portal required by |
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Subsection (b)(6). |
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SECTION 2. Not later than January 1, 2021, the Health and |
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Human Services Commission, or an entity with whom the commission |
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contracts, shall develop and implement the single Internet portal |
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required by Section 533.0055, Government Code, as amended by this |
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Act. |
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SECTION 3. This Act takes effect September 1, 2019. |