Bill Text: TX HB2731 | 2013-2014 | 83rd Legislature | Comm Sub


Bill Title: Relating to decreasing administrative burdens of Medicaid managed care for the state, the managed care organizations, and providers under managed care networks.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2013-05-03 - Committee report sent to Calendars [HB2731 Detail]

Download: Texas-2013-HB2731-Comm_Sub.html
  83R22752 JSL-D
 
  By: Raymond H.B. No. 2731
 
  Substitute the following for H.B. No. 2731:
 
  By:  Raymond C.S.H.B. No. 2731
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to decreasing administrative burdens of Medicaid managed
  care for the state, the managed care organizations, and providers
  under managed care networks.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 533.0071, Government Code, is amended to
  read as follows:
         Sec. 533.0071.  ADMINISTRATION OF CONTRACTS.  The
  commission shall make every effort to improve the administration of
  contracts with managed care organizations.  To improve the
  administration of these contracts, the commission shall:
               (1)  ensure that the commission has appropriate
  expertise and qualified staff to effectively manage contracts with
  managed care organizations under the Medicaid managed care program;
               (2)  evaluate options for Medicaid payment recovery
  from managed care organizations if the enrollee dies or is
  incarcerated or if an enrollee is enrolled in more than one state
  program or is covered by another liable third party insurer;
               (3)  maximize Medicaid payment recovery options by
  contracting with private vendors to assist in the recovery of
  capitation payments, payments from other liable third parties, and
  other payments made to managed care organizations with respect to
  enrollees who leave the managed care program;
               (4)  decrease the administrative burdens of managed
  care for the state, the managed care organizations, and the
  providers under managed care networks to the extent that those
  changes are compatible with state law and existing Medicaid managed
  care contracts, including decreasing those burdens by:
                     (A)  where possible, decreasing the duplication
  of administrative reporting requirements for the managed care
  organizations, such as requirements for the submission of encounter
  data, quality reports, historically underutilized business
  reports, and claims payment summary reports;
                     (B)  allowing managed care organizations to
  provide updated address information directly to the commission for
  correction in the state system;
                     (C)  promoting consistency and uniformity among
  managed care organization policies, including policies relating to
  the [preauthorization process,] lengths of hospital stays, filing
  deadlines, levels of care, and case management services;
                     (D)  developing uniform efficiency standards and
  requirements for managed care organizations for the submission and
  tracking of preauthorization requests for services provided under
  the Medicaid program [reviewing the appropriateness of primary
  care case management requirements in the admission and clinical
  criteria process, such as requirements relating to including a
  separate cover sheet for all communications, submitting
  handwritten communications instead of electronic or typed review
  processes, and admitting patients listed on separate
  notifications]; [and]
                     (E)  providing a [single] portal through which
  providers in any managed care organization's provider network may:
                           (i)  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
                           (ii)  obtain electronic remittance advice,
  explanation of benefits statements, and other standardized
  reports; [and]
                     (F)  requiring the use of standardized
  application processes and forms for prompt credentialing of
  providers in a managed care organization's network; and
                     (G)  promoting prompt and accurate adjudication
  of claims through:
                           (i)  provider education on the proper
  submission of clean claims and on appeals;
                           (ii)  acceptance of uniform forms, including
  the Centers for Medicare and Medicaid Services Forms 1500 and
  UB-92, through an electronic portal; and
                           (iii)  the establishment of standards for
  claims payments in accordance with a provider's contract;
               (5)  reserve the right to amend the managed care
  organization's process for resolving provider appeals of denials
  based on medical necessity to include an independent review process
  established by the commission for final determination of these
  disputes;
               (6)  monitor and evaluate a managed care organization's
  compliance with contractual requirements regarding:
                     (A)  the reduction of administrative burdens for
  network providers; and
                     (B)  complaints regarding claims adjudication or
  payment;
               (7)  measure the rates of retention by managed care
  organizations of significant traditional providers; and
               (8)  develop adequate and clearly defined provider
  network standards that are specific to provider type and that
  ensure choice among multiple providers to the greatest extent
  possible.
         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.  This Act takes effect September 1, 2013.
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