SB 73: Medicaid MCO Billing

Senator Borris Miles passed Senate Bill 73, which requires Managed Care Organizations (MCOs) to update their contracts and panels to include local health departments as a provider type that can seek reimbursement.

The provider type designation is the first step mitigating administrative burdens that local health departments experience when attempting to contract and complete the credentialing process as they do not for the most part function like primary care providers.

In FY19, the Houston Health Department (HHD) submitted over $700,000 in charges to Medicaid plans but only received reimbursements for $260,000 (37%). This is due, in large part, to not being able to contracts with MCOs.

In Article IX of the budget, a contingency rider to pay for this change was adopted and included in the final conference committee report for the budget. It reads:

“Sec. 18.34. Contingency for Senate Bill 73, House Bill 1666, or House Bill 3834. Contingent on enactment of Senate Bill 73, House Bill 1666, House Bill 3834, or similar legislation relating to providing access to local public health entities and certain health service regional offices under Medicaid, by the Eighty-seventh Legislature, Regular Session, in order to implement the provisions of the legislation:

  1. The Health and Human Services Commission is appropriated $665,000 from General Revenue and $665,000 for fiscal year 2022 and the commission’s capital budget authority is increased by $1,330,000 fiscal year 2022; and
  2. The Department of State Health Services is appropriated $347,000 from General Revenue for fiscal year 2022 and the department’s capital budget authority is increased by $245,000 for fiscal year 2022.”

Senate Bill 73 allows HHD to enter into contracts with MCOs, allowing HHD to maximize reimbursements. House Public Health Chair Stephanie Klick carried the bill on the House side, showing what a priority the measure is for the statewide public health system.