Bill Text: TX HB5018 | 2023-2024 | 88th Legislature | Comm Sub

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Bill Title: Relating to certain payment recovery efforts by managed care organizations under Medicaid or the child health plan program.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2023-05-11 - Placed on General State Calendar [HB5018 Detail]

Download: Texas-2023-HB5018-Comm_Sub.html

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88R25713 KKR-D
By: Raymond H.B. No. 5018
Substitute the following for H.B. No. 5018:
By: Frank C.S.H.B. No. 5018

A BILL TO BE ENTITLED
AN ACT
relating to certain payment recovery efforts by managed care
organizations under Medicaid or the child health plan program.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 531.1131, Government Code, is amended by
amending Subsection (f) and adding Subsection (g) 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 and
Section 531.1135 provide:
(1) written notice to a provider required to use
electronic visit verification of the organization's intent to
recoup overpayments in accordance with Section 531.1135; and
(2) any [a] provider [described by Subdivision (1)] at
least 60 days after the provider has exhausted all rights to an
appeal to cure any defect in a claim, including by submitting
necessary documentation for the claim or resubmitting the claim,
before the organization may begin any efforts to collect
overpayments.
(g) 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 under this section or
Section 531.1135, in conducting an audit or other review of a claim
for which the organization granted prior authorization, may not
review:
(1) the medical necessity determination; or
(2) an error in the claim documentation, if the error
was not made by the provider.
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.