bill giving Medicaid providers 120 days’ notice to revalidate

The text as introduced · 378 words

89R9329 LRM-D

By: Guerra
H.B. No. 4123

A BILL TO BE ENTITLED

AN ACT

relating to Medicaid provider enrollment revalidation.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Subchapter D, Chapter 532, Government Code, as

effective April 1, 2025, is amended by adding Section 532.01511 to

read as follows:

Sec. 532.01511. REVALIDATION OF PROVIDER ENROLLMENT. (a)

At least 120 days before the date a Medicaid provider's Medicaid

enrollment period expires, the commission shall provide to the

provider written notice of the upcoming expiration. The notice must

include:

(1) the date on which the provider's enrollment will

expire; and

(2) information on the process for revalidating the

provider's enrollment, including:

(A) the form and manner for applying for

revalidation;

(B) the information and documentation the

provider must submit with an application for revalidation of

enrollment; and

(C) a suggested timeline for submitting the

application, including the required information and documentation,

to ensure timely reenrollment and avoid disenrollment for failure

to revalidate enrollment before the provider's enrollment period

expires.

(b) If a Medicaid provider submits an application for

revalidation of enrollment at least 60 days before the date a

Medicaid provider's Medicaid enrollment period expires, the

commission shall conduct an initial review of the application to

determine whether the application contains any obvious

deficiencies. If the commission identifies a deficiency, the

commission shall:

(1) notify the provider of the deficiency at least 45

days before the date the provider's enrollment period expires;

(2) provide the provider at least 10 days to correct

the deficiency; and

(3) if the provider corrects the deficiency within the

time provided under Subdivision (2), complete a full review of the

application before the date the provider's enrollment period

expires.

SECTION 2. Section 532.01511, Government Code, as added by

this Act, applies only to a Medicaid provider whose enrollment

period expires on or after January 1, 2026.

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, 2025.