Alvarado Bill Lets Any Agency Rule Waive Its Medicare Requirement

The text as introduced · 480 words

89R4910 AND-D

By: Alvarado
S.B. No. 2348

A BILL TO BE ENTITLED

AN ACT

relating to Medicare provider certification and enrollment

prerequisites to Medicaid and child health plan program provider

enrollment.

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 532.0159 to

read as follows:

Sec. 532.0159. MEDICARE PROVIDER CERTIFICATION OR

ENROLLMENT AS PREREQUISITE TO MEDICAID PROVIDER ENROLLMENT. (a)

This section applies only to a provider that has not been terminated

or excluded from participating as a provider under Medicare,

another state's Medicaid program, or the child health plan program.

(b) To participate as a provider in Medicaid, a provider

must be certified for enrollment or enrolled as a provider in

Medicare unless the provider is exempted as provided by Subsection

(c).

(c) A provider is exempt from the Medicare certification or

enrollment requirement under Subsection (b) if:

(1) the provider's type of practice or health care

services offered are not covered by Medicare;

(2) the provider's exclusion from Medicaid

participation on the basis of the lack of Medicare certification or

enrollment will restrict a recipient's access to necessary

services; or

(3) a commission or other state agency rule expressly

exempts the provider from the Medicare certification or enrollment

requirement.

SECTION 2. Subchapter D, Chapter 62, Health and Safety

Code, is amended by adding Section 62.1562 to read as follows:

Sec. 62.1562. MEDICARE PROVIDER CERTIFICATION OR

ENROLLMENT AS PREREQUISITE TO CHILD HEALTH PLAN PROGRAM HEALTH CARE

PROVIDER ENROLLMENT. (a) This section applies only to a health

care provider that has not been terminated or excluded from

participating as a provider under Medicare or this state's or

another state's Medicaid program.

(b) To participate as a health care provider in the child

health plan program, a health care provider must be certified for

enrollment or enrolled as a provider in Medicare unless the

provider is exempted as provided by Subsection (c).

(c) A health care provider is exempt from the Medicare

provider certification or enrollment requirement under Subsection

(b) if:

(1) the provider's type of practice or health care

services offered are not covered by Medicare;

(2) the provider's exclusion from child health plan

program participation on the basis of the lack of Medicare

certification or enrollment will restrict an enrollee's access to

necessary health care services; or

(3) a commission or other state agency rule expressly

exempts the provider from the Medicare certification or enrollment

requirement.

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.