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.