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) 2019-05-17 - Committee report sent to Calendars [SB1235 Detail]

Download: Texas-2019-SB1235-Comm_Sub.html
  By: Buckingham S.B. No. 1235
  relating to the enrollment of health care providers in Medicaid.
         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 [may]:
               (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 
  [in the database established under Subchapter C, Chapter 32, Human
  Resources Code, with the centralized credentialing entity]; and
               (2)  [require] all managed care organizations
  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
         (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
         SECTION 4.  This Act takes effect September 1, 2019.