87R6076 JG-D
	By: Raymond	H.B. No. 1625

	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, 2023, 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, 2021.