Bill Text: TX SB862 | 2023-2024 | 88th Legislature | Introduced


Bill Title: Relating to the audit of claims and recovery of overpayments by Medicaid recovery audit contractors.

Spectrum: Partisan Bill (Republican 1-0)

Status: (Introduced - Dead) 2023-03-01 - Referred to Health & Human Services [SB862 Detail]

Download: Texas-2023-SB862-Introduced.html
  88R1364 AMF-F
 
  By: Hughes S.B. No. 862
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the audit of claims and recovery of overpayments by
  Medicaid recovery audit contractors.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 531.117, Government Code, is amended to
  read as follows:
         Sec. 531.117.  RECOVERY AUDIT CONTRACTORS.  (a) To the
  extent required under Section 1902(a)(42), Social Security Act (42
  U.S.C. Section 1396a(a)(42)), the commission shall establish a
  program under which the commission contracts with one or more
  recovery audit contractors for purposes of identifying
  underpayments and overpayments under Medicaid, including under the
  Medicaid managed care program, and recovering the overpayments.
         (b)  The commission's office of inspector general shall
  ensure that a recovery audit contractor:
               (1)  in identifying underpayments and overpayments
  under the Medicaid managed care program, identifies both payments
  made to a Medicaid managed care organization and payments made by a
  Medicaid managed care organization that the organization did not
  previously identify in an audit and for which the organization did
  not initiate recovery efforts; and
               (2)  makes efforts to recover identified overpayments.
         (c)  A Medicaid managed care organization may audit a claim
  the organization paid until the first anniversary of the date the
  organization paid the claim for purposes of determining whether the
  organization made an overpayment and initiating recovery efforts.
         (d)  Not earlier than the first anniversary of the date a
  Medicaid managed care organization paid a claim and not later than
  the second anniversary of that date, a recovery audit contractor
  may audit the claim, identify whether the organization made an
  overpayment, and initiate recovery of any overpayment. The recovery
  audit contractor may recover an identified overpayment until the
  third anniversary of the date the organization made the
  overpayment.
         SECTION 2.  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 3.  This Act takes effect September 1, 2023.
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