Medicaid providers get a dedicated sign-up support team

The text as introduced · 508 words

89R4745 CMO-F

By: Alvarado
S.B. No. 1266

A BILL TO BE ENTITLED

AN ACT

relating to Medicaid provider enrollment and credentialing

processes.

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 Sections 532.01511

and 532.01512 to read as follows:

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 30 days 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 will be disenrolled.

SECTION 2. Notwithstanding Section 532.01511, Government

Code, as added by this Act, the Health and Human Services Commission

shall conduct the initial evaluation and post the report

summarizing the results of the evaluation as required by that

section not later than September 1, 2026.

SECTION 3. As soon as possible after the effective date of

this Act, the Health and Human Services Commission shall:

(1) ensure the Internet portal support team required

by Section 532.01511(a), Government Code, as added by this Act, is

established; and

(2) adopt rules necessary to implement the changes in

law made by this Act.

SECTION 4. 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 5. This Act takes effect September 1, 2025.