Bill Text: TX HB3452 | 2013-2014 | 83rd Legislature | Introduced
Bill Title: Relating to administrative and judicial review of certain Medicaid reimbursement disputes.
Sponsorship: Partisan Bill (Democrat 1)
Status: (Introduced - Dead) 2013-04-22 - Committee report sent to Calendars [HB3452 Detail]
Download: Texas-2013-HB3452-Introduced.html
| 83R10419 ADM-F | ||
| By: Eiland | H.B. No. 3452 | |
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| relating to administrative and judicial review of certain Medicaid | ||
| reimbursement disputes. | ||
| BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
| SECTION 1. Subchapter B, Chapter 531, Government Code, is | ||
| amended by adding Subsection 531.02115 to read as follows: | ||
| Sec. 531.02115. ADMINISTRATIVE AND JUDICIAL REVIEW OF | ||
| REIMBURSEMENT DISPUTES UNDER MEDICAID PROGRAM. (a) A provider has | ||
| the right to a contested case hearing to dispute the amount of a | ||
| reimbursement rate paid to the provider under the fee-for-service | ||
| Medicaid program or by a managed care organization under the | ||
| managed care Medicaid program if the provider maintains that the | ||
| rate is below the rate necessary to recover the provider's | ||
| reasonable operating expenses and to realize a reasonable return on | ||
| the provider's investments that is sufficient to ensure confidence | ||
| in the provider's continued financial integrity. | ||
| (b) A contested case hearing under this section must be | ||
| conducted by a hearing officer in the manner provided for contested | ||
| case hearings under Subchapter C, Chapter 2001. | ||
| (c) Parties to a contested case hearing under this section | ||
| must include: | ||
| (1) the commission; and | ||
| (2) in a dispute involving a payment made by a managed | ||
| care organization, the managed care organization. | ||
| (d) Exhaustion of contractual remedies with a managed care | ||
| organization or its agent is not a prerequisite to a contested case | ||
| hearing under this section. | ||
| (e) In the absence of a timely appeal for judicial review | ||
| under Subsection (f), the decision of a hearing officer under this | ||
| section is final. | ||
| (f) Judicial review of a decision or order of a hearing | ||
| officer is governed by Subchapter G, Chapter 2001, except that the | ||
| party seeking judicial review must file suit not later than the 45th | ||
| day after the date notice of the decision made by the hearing | ||
| officer was mailed. | ||
| SECTION 2. The change in law made by this Act applies only | ||
| to a reimbursement paid to a Medicaid provider on or after the | ||
| effective date of this Act. | ||
| 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 immediately if it receives | ||
| a vote of two-thirds of all the members elected to each house, as | ||
| provided by Section 39, Article III, Texas Constitution. If this | ||
| Act does not receive the vote necessary for immediate effect, this | ||
| Act takes effect September 1, 2013. | ||
