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) 2019-03-26 - Left pending in committee [HB2221 Detail]

Download: Texas-2019-HB2221-Introduced.html
  By: Raymond H.B. No. 2221
  relating to a single Internet portal through which Medicaid
  providers may submit and receive information.
         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
                     (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 [electronic
  process, including the use of an] Internet portal[,] through which
  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
               (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 [an electronic process under]
  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
         (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
         (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
         SECTION 3.  This Act takes effect September 1, 2019.