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
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 |
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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[ |
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(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. |