HB 5512 — Relating to the participation and reimbursement of and requirements affecting certain providers, including providers of eye health care and vision care services, under Medicaid.

Summary

Relating to the participation and reimbursement of and requirements affecting certain providers, including providers of eye health care and vision care services, under Medicaid.

Bill Text

AI-generated reading aid from the bill's amendatory text — verify against the official bill.

This bill amends 1 section(s) of the Texas statutes: Section 540.0651(a), Government Code.

• Sec. 532.01511. PROVIDER ENROLLMENT AND CREDENTIALING PROCESSES: PROVIDER SUPPORT; COMPLAINTS. (a) The commission shall ensure that providers have access to a dedicated support team for the Internet portal established under Section 532.0151 that: (1) assists current and prospective Medicaid providers in completing the Medicaid provider enrollment and credentialing processes; and (2) reduces the administrative burdens associated with those processes. (b) The commission shall: (1) annually evaluate the performance of the support team described by Subsection (a), including the timeliness of assistance the support team provides; and (2) not later than September 1 of each year, post on the commission's Internet website a report summarizing the results of the evaluation conducted under Subdivision (1). (c) For purposes of improving the commission's Medicaid provider enrollment and credentialing processes, the commission shall develop a procedure by which a provider may electronically submit complaints and feedback about those processes and the support provided by the support team described by Subsection (a). Information about the procedure must: (1) be prominently posted on the commission's or the commission's designee's Internet website in the same location that instructions and resources for using the Internet portal established under Section 532.0151 are posted; and (2) allow a provider to submit a complaint or provide feedback through an electronic form from that location. Sec. 532.01512. NOTICE OF PROVIDER DISENROLLMENT. Before the commission may disenroll a Medicaid provider during the provider's enrollment revalidation period, the commission must: (1) not later than the 30th day before the date of disenrollment provide electronically and by mail to the provider written notice of the commission's disenrollment determination; and (2) allow the provider to address any deficiencies in the provider's application for revalidation of enrollment before the date the provider is disenrolled.

  amended

• Sec. 540.0281. ADMINISTRATION OF EYE HEALTH CARE AND VISION CARE SERVICES. (a) A contract to which this subchapter applies must prohibit the contracting Medicaid managed care organization from using a different insurer, health maintenance organization, third-party administrator, managed care plan, vision plan, or other plan or entity the organization contracts with, offers, owns, or otherwise engages to provide or arrange for the provision of eye health care or vision care services under the managed care plan the Medicaid managed care organization offers to: (1) establish an eye health care services provider's inclusion in the organization's provider network; (2) contract with an eye health care services provider to provide or arrange for the provision of eye health care or vision care services under the organization's Medicaid managed care plan; (3) reduce, restrict, or limit eye health care or vision care services that are required to be provided to recipients and are within the eye health care services provider's scope of practice; or (4) deny participation of an eye health care services provider in the organization's Medicaid managed care plan if the provider: (A) seeks to participate in that plan; and (B) meets the organization's requirements for participation in the plan. (b) Notwithstanding Section 1451.152, Insurance Code, an insurer, health maintenance organization, third-party administrator, managed care plan, vision plan, or other plan or entity that a Medicaid managed care organization contracts with, offers, owns, or otherwise engages to provide or arrange for the provision of eye health care or vision care services under the organization's Medicaid managed care plan shall comply with the requirements of Subchapter D, Chapter 1451, Insurance Code. Sec. 540.0282. REIMBURSEMENT OF EYE HEALTH CARE SERVICES PROVIDERS. A contract to which this subchapter applies must require that the contracting Medicaid managed care organization require any insurer, health maintenance organization, third-party administrator, managed care plan, vision plan, or other plan or entity the organization contracts with, offers, owns, or otherwise engages to provide or arrange for the provision of eye health care or vision care services under the managed care plan the Medicaid managed care organization offers to reimburse an eye health care services provider who provides services to a recipient under the organization's managed care plan at a rate that is at least equal to the Medicaid fee-for-service rate for the provision of the same or similar services.

  amended

• Section 540.0651(a), Government Code

  and (B) organization's prevailing provider contract (C) (D) → seeks participation in the organization's provider network; (B) (C) specified in the contract between the provider and the organization (D) (E) ; and (4) contract directly with each provider described by Subdivision (3) to participate in the organization's provider network

  amended

Action History

1. April 07, 2025

   Referred to Human Services

2. April 07, 2025

   Read first time

3. March 14, 2025

   Filed

Sponsors

• Brad Buckley · Primary

Subjects