Bill Text: TX SB1235 | 2019-2020 | 86th Legislature | Comm Sub
Bill Title: Relating to the enrollment of health care providers in Medicaid.
Spectrum: Partisan Bill (Republican 2-0)
Status: (Engrossed - Dead) 2019-05-17 - Committee report sent to Calendars [SB1235 Detail]
Download: Texas-2019-SB1235-Comm_Sub.html
By: Buckingham | S.B. No. 1235 | |
(Oliverson) | ||
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relating to the enrollment of health care providers in Medicaid. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Section 531.02118, Government Code, is amended | ||
by amending Subsection (c) and adding Subsections (e), (f), (g), | ||
(h), and (i) to read as follows: | ||
(c) In streamlining the Medicaid provider credentialing | ||
process under this section, the commission may designate a | ||
centralized credentialing entity and shall require [ |
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(1) that the credentialing entity and the entity | ||
serving as the state's Medicaid claims administrator share | ||
information to reduce the submission of duplicative information or | ||
documents necessary for both Medicaid enrollment and credentialing | ||
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(2) [ |
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contracting with the commission to provide health care services to | ||
Medicaid recipients under a managed care plan issued by the | ||
organization to use the centralized credentialing entity as a hub | ||
for the collection and sharing of information. | ||
(e) Subject to Subsection (f), the commission shall enroll a | ||
provider as a Medicaid provider, without requiring the provider to | ||
separately apply for enrollment through the entity serving as the | ||
state's Medicaid claims administrator, if the provider is: | ||
(1) credentialed by a managed care organization that | ||
contracts with the commission under Chapter 533; or | ||
(2) enrolled as a Medicare provider. | ||
(f) The executive commissioner by rule may establish | ||
additional enrollment requirements that are: | ||
(1) necessary to enroll a provider as a Medicaid | ||
provider; and | ||
(2) not otherwise required by managed care | ||
organization credentialing or Medicare provider enrollment. | ||
(g) The commission shall track the number of providers that | ||
enroll as Medicaid providers through each type of enrollment | ||
process described by Subsection (e), including the enrollment | ||
process through the entity serving as the state's Medicaid claims | ||
administrator. | ||
(h) The commission shall develop a process to streamline the | ||
Medicaid enrollment of a provider who: | ||
(1) provides services through a single case agreement | ||
to a recipient who is also enrolled in a private group health | ||
benefit plan; and | ||
(2) is enrolled as a provider in that group health | ||
benefit plan. | ||
(i) The commission shall use a provider's national provider | ||
identifier number to enroll a provider under Subsection (h). In | ||
this subsection, "national provider identifier number" means the | ||
national provider identifier number required under Section | ||
1128J(e), Social Security Act (42 U.S.C. Section 1320a-7k(e)). | ||
SECTION 2. 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 3. The Health and Human Services Commission is | ||
required to implement a provision of this Act only if the | ||
legislature appropriates money specifically for that purpose. If | ||
the legislature does not appropriate money specifically for that | ||
purpose, the commission may, but is not required to, implement a | ||
provision of this Act using other appropriations available for that | ||
purpose. | ||
SECTION 4. This Act takes effect September 1, 2019. |