Bill Text: TX HB4192 | 2019-2020 | 86th Legislature | Introduced


Bill Title: Relating to claims and overpayment recoupment processes imposed on health care providers under Medicaid and other public benefits programs.

Spectrum: Partisan Bill (Republican 1-0)

Status: (Introduced) 2019-04-23 - Left pending in committee [HB4192 Detail]

Download: Texas-2019-HB4192-Introduced.html
  86R13429 KFF-F
 
  By: Klick H.B. No. 4192
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to claims and overpayment recoupment processes imposed on
  health care providers under Medicaid and other public benefits
  programs.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 531.024172, Government Code, is amended
  by amending Subsection (g) and adding Subsection (g-1) to read as
  follows:
         (g)  The commission may recognize a health care provider's
  proprietary electronic visit verification system, whether
  purchased or developed by the provider, as complying with this
  section and allow the health care provider to use that system for a
  period determined by the commission if the commission determines
  that the system:
               (1)  complies with all necessary data submission,
  exchange, and reporting requirements established under this
  section; and
               (2)  meets all other standards and requirements
  established under this section[; and
               [(3)     has been in use by the health care provider since
  at least June 1, 2014].
         (g-1)  The commission or a managed care organization shall
  reimburse a health care provider providing services to a Medicaid
  recipient at the same reimbursement rate for the same service
  regardless of whether the provider uses the electronic visit
  verification system implemented under Subsection (b) or the
  provider's own proprietary electronic visit verification system
  under Subsection (g).
         SECTION 2.  Section 531.1131, Government Code, is amended by
  adding Subsection (f) to read as follows:
         (f)  In adopting rules establishing due process procedures
  under Subsection (e), the executive commissioner shall require that
  a managed care organization or an entity with which the managed care
  organization contracts under Section 531.113(a)(2) that engages in
  payment recovery efforts in accordance with this section provide:
               (1)  written notice to a provider of the organization's
  intent to recoup overpayments; and
               (2)  a provider described by Subdivision (1) at least
  60 days to cure any defect in a claim before the organization may
  begin any efforts to collect overpayments. 
         SECTION 3.  Subchapter C, Chapter 531, Government Code, is
  amended by adding Section 531.1135 to read as follows:
         Sec. 531.1135.  MANAGED CARE ORGANIZATIONS: PROCESS TO
  RECOUP CERTAIN OVERPAYMENTS. (a) The executive commissioner shall
  adopt rules that standardize the process by which a managed care
  organization collects alleged overpayments that are made to a
  health care provider and discovered through an audit or
  investigation conducted by the organization secondary to missing
  electronic visit verification information. In adopting rules under
  this section, the executive commissioner shall require that the
  managed care organization:
               (1)  provide written notice of the organization's
  intent to recoup overpayments not later than the 30th day after the
  date an audit is complete; and
               (2)  limit the duration of audits to 24 months.
         (b)  The executive commissioner shall require that the
  notice required under this section inform the provider: 
               (1)  of the specific claims and electronic visit
  verification transactions that are the basis of the overpayment;
               (2)  of the process the provider should use to
  communicate with the managed care organization to provide
  information about the electronic visit verification transactions;
               (3)  of the provider's option to seek an informal
  resolution of the alleged overpayment;
               (4)  of the process to appeal the determination that an
  overpayment was made; and
               (5)  if the provider intends to respond to the notice,
  that the provider must respond not later than the 30th day after the
  date the provider receives the notice.
         (c)  Notwithstanding any other law, a managed care
  organization may not attempt to recover an overpayment described by
  Subsection (a) until the provider has exhausted all rights to an
  appeal.
         SECTION 4.  If before implementing any provision of this Act
  a state agency determines that an additional waiver or additional
  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 5.  This Act takes effect September 1, 2019.
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