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  S.B. No. 1150
  relating to a provider protection plan that ensures efficiency and
  reduces administrative burdens on providers participating in a
  Medicaid managed care model or arrangement.
         SECTION 1.  Subchapter A, Chapter 533, Government Code, is
  amended by adding Section 533.0055 to read as follows:
         Sec. 533.0055.  PROVIDER PROTECTION PLAN. (a)  The
  commission shall develop and implement a provider protection plan
  that is designed to reduce administrative burdens placed on
  providers participating in a Medicaid managed care model or
  arrangement implemented under this chapter and to ensure efficiency
  in provider enrollment and reimbursement.  The commission shall
  incorporate the measures identified in the plan, to the greatest
  extent possible, into each contract between a managed care
  organization and the commission for the provision of health care
  services to recipients.
         (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
                     (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 electronic portal; 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 the Medicaid
               (6)  establishment of an electronic process, including
  the use of an Internet portal, 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
               (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 an
  electronic process under Subdivision (6) and, for any requirement
  that is not implemented immediately, recommendations regarding the
                     (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
         SECTION 2.  As soon as possible, but not later than September
  1, 2014, the Health and Human Services Commission shall implement
  the provider protection plan required under Section 533.0055,
  Government Code, as added by this Act.
         SECTION 3.  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 4.  This Act takes effect September 1, 2013.
  ______________________________ ______________________________
     President of the Senate Speaker of the House     
         I hereby certify that S.B. No. 1150 passed the Senate on
  May 9, 2013, by the following vote: Yeas 30, Nays 0; and that the
  Senate concurred in House amendments on May 24, 2013, by the
  following vote: Yeas 31, Nays 0.
  Secretary of the Senate    
         I hereby certify that S.B. No. 1150 passed the House, with
  amendments, on May 21, 2013, by the following vote: Yeas 141,
  Nays 4, two present not voting.
  Chief Clerk of the House