Bill Text: TX HB2221 | 2019-2020 | 86th Legislature | Introduced
Bill Title: Relating to a single Internet portal through which Medicaid providers may submit and receive information.
Spectrum: Bipartisan Bill
Status: (Introduced - Dead) 2019-03-26 - Left pending in committee [HB2221 Detail]
Download: Texas-2019-HB2221-Introduced.html
By: Raymond | H.B. No. 2221 |
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relating to a single Internet portal through which Medicaid | ||
providers may submit and receive information. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Section 533.0055, Government Code, is amended by | ||
amending Subsection (b) and adding Subsections (c), (d), and (e) to | ||
read as follows: | ||
(b) The provider protection plan required under this | ||
section must provide for: | ||
(1) prompt payment and proper reimbursement of | ||
providers by managed care organizations; | ||
(2) prompt and accurate adjudication of claims | ||
through: | ||
(A) provider education on the proper submission | ||
of clean claims and on appeals; | ||
(B) acceptance of uniform forms, including HCFA | ||
Forms 1500 and UB-92 and subsequent versions of those forms, | ||
through an electronic portal; and | ||
(C) the establishment of standards for claims | ||
payments in accordance with a provider's contract; | ||
(3) adequate and clearly defined provider network | ||
standards that are specific to provider type, including physicians, | ||
general acute care facilities, and other provider types defined in | ||
the commission's network adequacy standards in effect on January 1, | ||
2013, and that ensure choice among multiple providers to the | ||
greatest extent possible; | ||
(4) a prompt credentialing process for providers; | ||
(5) uniform efficiency standards and requirements for | ||
managed care organizations for the submission and tracking of | ||
preauthorization requests for services provided under Medicaid; | ||
(6) establishment and maintenance of an [ |
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providers in any managed care organization's provider network may: | ||
(A) submit electronic claims, prior | ||
authorization requests, claims appeals and reconsiderations, | ||
clinical data, and other documentation that the managed care | ||
organization requests for prior authorization and claims | ||
processing; and | ||
(B) obtain electronic remittance advice, | ||
explanation of benefits statements, and other standardized | ||
reports; | ||
(7) the measurement of the rates of retention by | ||
managed care organizations of significant traditional providers; | ||
(8) the creation of a work group to review and make | ||
recommendations to the commission 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 [ |
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Subdivision (6) and, for any requirement that is not implemented | ||
immediately, recommendations regarding the expected: | ||
(A) fiscal impact of implementing the | ||
requirement; and | ||
(B) timeline for implementation of the | ||
requirement; and | ||
(9) any other provision that the commission determines | ||
will ensure efficiency or reduce administrative burdens on | ||
providers participating in a Medicaid managed care model or | ||
arrangement. | ||
(c) The commission shall consolidate each electronic or | ||
Internet portal operated or maintained by the commission, 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). | ||
The commission | ||
shall ensure the single Internet portal meets the requirements of a | ||
portal described by Sections 531.02411, 533.00251, 533.002553, and | ||
533.0071. | ||
(d) The commission may contract with a private or nonprofit | ||
entity to develop, operate, and maintain the single Internet portal | ||
required by Subsection (b)(6). The entity may not be affiliated | ||
with any specific managed care plan. | ||
(e) Notwithstanding any other law, the executive | ||
commissioner by rule shall 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. Not later than January 1, 2021, the Health and | ||
Human Services Commission, or an entity with whom the commission | ||
contracts, shall develop and implement the single Internet portal | ||
required by Section 533.0055, Government Code, as amended by this | ||
Act. | ||
SECTION 3. This Act takes effect September 1, 2019. |