Bill Text: TX HB2478 | 2011-2012 | 82nd Legislature | Introduced

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Bill Title: Relating to the provision of nonemergency medical services to Medicaid recipients and reimbursement for those services.

Spectrum: Partisan Bill (Republican 1-0)

Status: (Introduced - Dead) 2011-04-06 - Left pending in committee [HB2478 Detail]

Download: Texas-2011-HB2478-Introduced.html

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82R9349 KLA-D
By: Perry H.B. No. 2478

A BILL TO BE ENTITLED
AN ACT
relating to the provision of nonemergency medical services to
Medicaid recipients and reimbursement for those services.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter B, Chapter 531, Government Code, is
amended by adding Section 531.02193 to read as follows:
Sec. 531.02193. ACCESS TO COMMUNITY HEALTH CLINICS. The
executive commissioner shall adopt policies designed to improve
Medicaid recipient access to nonemergency medical services by
encouraging federally qualified health centers, as defined by
Section 531.02192, and other community health clinics that provide
services to Medicaid recipients to maintain hours of operation that
include evening hours until at least 10 p.m.
SECTION 2. Section 32.0641, Human Resources Code, is
amended to read as follows:
Sec. 32.0641. REIMBURSEMENT [COST SHARING] FOR CERTAIN
NONEMERGENCY [HIGH-COST] MEDICAL SERVICES. (a) To [If the
department determines that it is feasible and cost-effective, and
to] the extent permitted under Title XIX, Social Security Act (42
U.S.C. Section 1396 et seq.) and any other applicable law or
regulation or under a federal waiver or other authorization and
except as provided by Subsection (c), the department [executive
commissioner of the Health and Human Services Commission] shall
deny medical assistance reimbursement for the provision of a
nonemergency [adopt cost-sharing provisions that require a
recipient who chooses a high-cost] medical service to a medical
assistance recipient [provided] through a hospital emergency room
unless, at the time the recipient is seeking care, there is no
nonemergency medical services provider available within 50 miles of
the hospital emergency room that could provide the service to the
recipient [to pay a copayment, premium payment, or other
cost-sharing payment for the high-cost medical service if:
[(1) the hospital from which the recipient seeks
service:
[(A) performs an appropriate medical screening
and determines that the recipient does not have a condition
requiring emergency medical services;
[(B) informs the recipient:
[(i) that the recipient does not have a
condition requiring emergency medical services;
[(ii) that, if the hospital provides the
nonemergency service, the hospital may require payment of a
copayment, premium payment, or other cost-sharing payment by the
recipient in advance; and
[(iii) of the name and address of a
nonemergency Medicaid provider who can provide the appropriate
medical service without imposing a cost-sharing payment; and
[(C) offers to provide the recipient with a
referral to the nonemergency provider to facilitate scheduling of
the service; and
[(2) after receiving the information and assistance
described by Subdivision (1) from the hospital, the recipient
chooses to obtain emergency medical services despite having access
to medically acceptable, lower-cost medical services].
(a-1) The executive commissioner of the Health and Human
Services Commission shall adopt rules prescribing a process under
which a hospital emergency room that receives reimbursements under
the medical assistance program provides information to a medical
assistance recipient seeking nonemergency medical services at the
hospital emergency room regarding the availability of nonemergency
medical services providers. The rules must require the hospital
emergency room to:
(1) inform the recipient that the recipient's
condition is not an emergency medical condition;
(2) provide to the recipient a list of the names,
addresses, and hours of operation of nonemergency medical services
providers, including federally qualified health centers and other
community health centers, that are located within 50 miles of the
hospital emergency room and that could provide the services to the
recipient; and
(3) offer to provide the recipient with a referral to
the nonemergency medical services provider to facilitate
scheduling of the service.
(b) The department may not deny reimbursement [seek a
federal waiver or other authorization] under Subsection (a) if the
denial [that] would:
(1) prevent a Medicaid recipient who has a condition
requiring emergency medical services from receiving care through a
hospital emergency room; or
(2) waive any provision under Section 1867, Social
Security Act (42 U.S.C. Section 1395dd).
(c) The department may not deny reimbursement under the
medical assistance program for the provision of nonemergency
medical services provided in a hospital emergency room to a medical
assistance recipient who is younger than six years of age. [If the
executive commissioner of the Health and Human Services Commission
adopts a copayment or other cost-sharing payment under Subsection
(a), the commission may not reduce hospital payments to reflect the
potential receipt of a copayment or other payment from a recipient
receiving medical services provided through a hospital emergency
room.]
SECTION 3. 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 4. This Act takes effect September 1, 2011.