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


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
  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.
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