Bill Text: TX SB1991 | 2019-2020 | 86th Legislature | Engrossed

NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Relating to claims processes and reimbursement for, and overpayment recoupment processes imposed on, health care providers under Medicaid.

Spectrum: Slight Partisan Bill (Republican 2-1)

Status: (Passed) 2019-06-10 - Effective on 9/1/19 [SB1991 Detail]

Download: Texas-2019-SB1991-Engrossed.html
 
 
  By: Buckingham, Hinojosa S.B. No. 1991
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to claims and overpayment recoupment processes imposed on
  health care providers under Medicaid.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 531.024172, Government Code, is amended
  by amending Subsection (g) and adding Subsections (g-1) and (g-2)
  to read as follows:
         (g)  The commission may recognize a health care provider's
  proprietary electronic visit verification system, whether
  purchased or developed by the provider, as complying with this
  section and allow the health care provider to use that system for a
  period determined by the commission if the commission determines
  that the system:
               (1)  complies with all necessary data submission,
  exchange, and reporting requirements established under this
  section; and
               (2)  meets all other standards and requirements
  established under this section[; and
               [(3)     has been in use by the health care provider since
  at least June 1, 2014].
         (g-1)  If feasible, the executive commissioner shall ensure
  a health care provider that uses the provider's proprietary
  electronic visit verification system recognized under Subsection
  (g) is reimbursed for the use of that system.
         (g-2)  For purposes of facilitating the use of proprietary
  electronic visit verification systems by health care providers
  under Subsection (g) and in consultation with industry stakeholders
  and the work group established under Subsection (h), the commission
  or the executive commissioner, as appropriate, shall:
               (1)  develop an open model system that mitigates the
  administrative burdens identified by providers required to use
  electronic visit verification;
               (2)  allow providers to use emerging technologies,
  including Internet-based, mobile telephone-based, and global
  positioning-based technologies, in the providers' proprietary
  electronic visit verification systems; and
               (3)  adopt rules governing data submission and provider
  reimbursement.
         SECTION 2.  Section 531.1131, Government Code, is amended by
  adding Subsection (f) to read as follows:
         (f)  In adopting rules establishing due process procedures
  under Subsection (e), the executive commissioner shall require that
  a managed care organization or an entity with which the managed care
  organization contracts under Section 531.113(a)(2) that engages in
  payment recovery efforts in accordance with this section and
  Section 531.1135 provide:
               (1)  written notice to a provider required to use
  electronic visit verification of the organization's intent to
  recoup overpayments in accordance with Section 531.1135; and
               (2)  a provider described by Subdivision (1) at least
  60 days to cure any defect in a claim before the organization may
  begin any efforts to collect overpayments. 
         SECTION 3.  Subchapter C, Chapter 531, Government Code, is
  amended by adding Section 531.1135 to read as follows:
         Sec. 531.1135.  MANAGED CARE ORGANIZATIONS:  PROCESS TO
  RECOUP CERTAIN OVERPAYMENTS. (a)  The executive commissioner
  shall adopt rules that standardize the process by which a managed
  care organization collects alleged overpayments that are made to a
  health care provider and discovered through an audit or
  investigation conducted by the organization secondary to missing
  electronic visit verification information. In adopting rules under
  this section, the executive commissioner shall require that the
  managed care organization:
               (1)  provide written notice of the organization's
  intent to recoup overpayments not later than the 30th day after the
  date an audit is complete; and
               (2)  limit the duration of audits to 24 months.
         (b)  The executive commissioner shall require that the
  notice required under this section inform the provider: 
               (1)  of the specific claims and electronic visit
  verification transactions that are the basis of the overpayment;
               (2)  of the process the provider should use to
  communicate with the managed care organization to provide
  information about the electronic visit verification transactions;
               (3)  of the provider's option to seek an informal
  resolution of the alleged overpayment;
               (4)  of the process to appeal the determination that an
  overpayment was made; and
               (5)  if the provider intends to respond to the notice,
  that the provider must respond not later than the 30th day after the
  date the provider receives the notice.
         (c)  Notwithstanding any other law, a managed care
  organization may not attempt to recover an overpayment described by
  Subsection (a) until the provider has exhausted all rights to an
  appeal.
         SECTION 4.  The Health and Human Services Commission is
  required to implement a provision of this Act only if the
  legislature appropriates money to the commission 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 that are available for that purpose.
         SECTION 5.  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 6.  This Act takes effect September 1, 2019.
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