bill requiring warning before Medicaid enrollment expires

The text as introduced · 426 words

89R15296 LRM-D

By: Guerra
H.B. No. 4845

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 90 days before the date a

Medicaid provider's Medicaid enrollment period expires, the

commission shall review 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 60

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), review the corrected

application in a timely manner to allow for any additional

deficiency to be determined and addressed before the date the

provider's enrollment period expires.

(c) If a Medicaid provider in good faith submits an

application for revalidation and complies with all specified

deadlines for corrections, the commission must finalize the

application before the provider's enrollment period expires,

regardless of the number of required corrections.

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.