An acute care Medicaid billing coordination system is mandated
by the Government Code §531.02413. The Health and Human Services
Commission (HHSC) will develop and implement an acute care Medicaid
billing coordination system for the fee-for-service delivery model
that identifies whether another entity has primary payor responsibility.
(1) An entity holding a permit, license, or certificate
of authority issued by a state regulatory agency must allow HHSC or
its designee to access databases that enable it to carry out the purposes
of this section. Entities subject to this section are those entities
that are, by statute, contract or agreement, legally responsible for
the payment of a claim for a health care item or service.
(2) HHSC shall refer any entity that violates this
rule to the regulatory agency issuing the permit, license, or certificate
of authority for possible administrative sanction.
(3) After September 1, 2008, no public funds shall
be expended on entities not in compliance with this section unless
a memorandum of understanding is entered into between the entity and
HHSC.
(4) Information obtained under this section must be
secure and maintain the confidentiality of the client's health records
in compliance with security and privacy rules adopted by the U.S.
Department of Health and Human Services under the Health Insurance
Portability and Accountability Act of 1996 (HIPAA), 45 C.F.R. §§164.302
- 164.318 and §§164.500 - 164.534.
(5) The administrator of the acute care Medicaid billing
coordination system shall be determined by HHSC. The administrator
shall be responsible for meeting all requirements of the acute care
Medicaid billing coordination system.
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