89R1441 KKR-F

By: Hughes S.B. No. 1334

A BILL TO BE ENTITLED

AN ACT

relating to the approval, selection, and use of an alternative electronic visit verification system under Medicaid.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Section 532.0257, Government Code, as effective April 1, 2025, is amended to read as follows:

Sec. 532.0257. HEALTH CARE PROVIDER COMPLIANCE. A health care provider that provides to recipients personal care services, attendant care services, or other services the commission identifies shall:

(1) use the electronic visit verification system or an alternative [a proprietary] system the commission approves [allows] as provided by Section 532.0258 to document the provision of those services;

(2) comply with all documentation requirements the commission establishes;

(3) comply with federal and state laws regarding confidentiality of recipients' information;

(4) ensure that the commission or the Medicaid managed care organization with which a claim for reimbursement for a service is filed may review electronic visit verification system documentation related to the claim or obtain a copy of that documentation at no charge to the commission or the organization; and

(5) at any time, allow the commission or a Medicaid managed care organization with which a health care provider contracts to provide health care services to recipients enrolled in the organization's managed care plan to have direct, on-site access to the electronic visit verification system in use by the health care provider.

SECTION 2. Section 532.0258, Government Code, as effective April 1, 2025, is amended to read as follows:

Sec. 532.0258. HEALTH CARE PROVIDER: USE OF ALTERNATIVE [PROPRIETARY] SYSTEM. (a) The commission may approve an alternative [recognize a health care provider's proprietary] electronic visit verification system, including a system [whether] purchased or developed by a health care [the] provider, as complying with this subchapter and allow a [the] health care provider to use the [that] system [for a period the commission determines] if the commission determines that the system[:

[(1) complies with all necessary data submission, exchange, and reporting requirements established under this subchapter; and

[(2)] meets all [other] standards and requirements, including electronic visit verification business rules, established under this subchapter.

(b) To the extent allowed by federal law [If feasible], the executive commissioner shall ensure the vendor of an approved alternative electronic visit verification system selected by a health care provider under this section is reimbursed for any electronic visit verification visit transaction costs if the [use of the provider's proprietary electronic visit verification] system maintains the minimum standards and requirements the commission establishes [recognizes].

(b-1) The commission shall:

(1) allow a health care provider to select, on a form the provider signs and in the manner the commission prescribes, any alternative electronic visit verification system the commission approves under this section;

(2) timely approve a provider's signed selection of the alternative system under Subdivision (1); and

(3) allow the provider a period of 90 days to implement the selected alternative system.

(b-2) The commission shall maintain a current list of alternative electronic visit verification systems the commission has approved. The list must:

(1) include:

(A) each alternative system the commission has approved under this section;

(B) contact information for the person from whom the alternative system may be obtained; and

(C) an electronic link to an alternative electronic visit verification system selection form for use by a health care provider in making a selection; and

(2) be prominently posted on the Internet website of the commission or the commission's designee in the same location that other information on alternative electronic visit verification systems under this subchapter is posted.

(b-3) The commission may not limit the number of alternative electronic visit verification systems approved under this section.

(c) For purposes of facilitating the use of alternative [proprietary] electronic visit verification systems by health care providers and in consultation with industry stakeholders and the work group established under Section 532.0259, the commission or the executive commissioner, as appropriate, shall:

(1) develop an open model system that mitigates the administrative burdens providers required to use electronic visit verification identify;

(2) allow providers to use emerging technologies, including Internet-based, mobile telephone-based, and global positioning-based technologies, in the alternative [providers' proprietary] electronic visit verification systems approved under this section;

(2-a) allow providers to choose a system that best meets the providers' needs, including, if the commission changes the vendor for the electronic visit verification system under Section 532.0253, continuing to use the previous vendor's system if the system meets commission standards and requirements; and

(3) adopt rules governing:

(A) data submission;

(B) [and provider] reimbursement of electronic visit verification visit transaction costs; and

(C) an efficient alternative electronic visit verification system approval process.

SECTION 3. As soon as possible after the effective date of this Act, the executive commissioner of the Health and Human Services Commission shall adopt rules necessary to implement Section 532.0258, Government Code, as amended by this Act.

SECTION 4. If before implementing any provision of this Act a state agency determines that a waiver or authorization from a federal agency is necessary for implementation of that provision, the agency affected by the provision shall request the waiver or authorization and may delay implementing that provision until the waiver or authorization is granted.

SECTION 5. This Act takes effect September 1, 2025.