Bill Text: TX SB2086 | 2019-2020 | 86th Legislature | Engrossed


Bill Title: Relating to a single Internet portal or equivalent electronic system through which Medicaid providers may submit and receive information.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Engrossed) 2019-05-16 - Referred to Human Services [SB2086 Detail]

Download: Texas-2019-SB2086-Engrossed.html
 
 
  By: Hinojosa S.B. No. 2086
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to a single Internet portal or equivalent electronic
  system 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), (e), and
  (f) 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 interoperable electronic portal or equivalent
  electronic system; 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 interoperable 
  [electronic process, including the use of an] Internet portal or
  equivalent electronic system with real-time capabilities[,]
  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
  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 or equivalent electronic system 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
  arrangement.
         (c)  The commission, using existing resources, shall
  consolidate each electronic or Internet portal operated or
  maintained by the commission for the commission's use, 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 or equivalent electronic system required by
  Subsection (b)(6).  The commission shall:
               (1)  ensure the single Internet portal or equivalent
  electronic system meets the requirements of a portal described by
  Sections 531.02411, 533.00251, 533.002553, and 533.0071; and
               (2)  implement a method that allows:
                     (A)  each managed care organization to connect
  with the single Internet portal or equivalent electronic system;
  and
                     (B)  a provider to access the single Internet
  portal or equivalent electronic system both directly and through a
  managed care organization's Internet website.
         (d)  The commission may contract with a private or nonprofit
  entity to develop, operate, and maintain the single Internet portal
  or equivalent electronic system required by Subsection (b)(6). The
  entity may not be affiliated with any specific managed care plan.
         (e)  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 or equivalent
  electronic system required by Subsection (b)(6).
         (f)  Notwithstanding any other law, a provider in a managed
  care organization's provider network may continue to use a provider
  portal made available by the managed care organization that is
  interoperable with the single Internet portal or equivalent
  electronic system, as applicable, required by Subsection (b)(6)
  instead of accessing the single Internet portal or equivalent
  electronic system directly.
         SECTION 2.  Not later than January 1, 2021, the Health and
  Human Services Commission, or an entity with which the commission
  contracts, shall develop and implement the single Internet portal
  or equivalent electronic system required by Section 533.0055,
  Government Code, as amended by this Act.
         SECTION 3.  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, 2019.
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