Bill Text: TX SB731 | 2023-2024 | 88th Legislature | Introduced
Bill Title: Relating to the proof required to impose payment holds in certain cases of alleged fraud by Medicaid providers.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2023-03-01 - Referred to Health & Human Services [SB731 Detail]
Download: Texas-2023-SB731-Introduced.html
88R6694 BDP-F | ||
By: Hinojosa | S.B. No. 731 |
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relating to the proof required to impose payment holds in certain | ||
cases of alleged fraud by Medicaid providers. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Section 531.102(g)(3), Government Code, is | ||
amended to read as follows: | ||
(3) On timely written request by a provider subject to | ||
a payment hold under Subdivision (2), other than a hold requested by | ||
the state's Medicaid fraud control unit, the office shall file a | ||
request with the State Office of Administrative Hearings for an | ||
expedited administrative hearing regarding the hold not later than | ||
the third day after the date the office receives the provider's | ||
request. The provider must request an expedited administrative | ||
hearing under this subdivision not later than the 10th day after the | ||
date the provider receives notice from the office under Subdivision | ||
(2). The State Office of Administrative Hearings shall hold the | ||
expedited administrative hearing not later than the 45th day after | ||
the date the State Office of Administrative Hearings receives the | ||
request for the hearing. In a hearing held under this subdivision: | ||
(A) the provider and the office are each limited | ||
to four hours of testimony, excluding time for responding to | ||
questions from the administrative law judge; | ||
(B) the provider and the office are each entitled | ||
to two continuances under reasonable circumstances; and | ||
(C) the office is required to show probable cause | ||
that the credible allegation of fraud that is the basis of the | ||
payment hold has an indicia of reliability and that continuing to | ||
pay the provider presents [ |
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(i) an ongoing risk that the alleged fraud | ||
could result in the provider or another person receiving an | ||
unauthorized benefit of more than $100,000; or | ||
(ii) the provider's conduct having resulted | ||
in a serious threat to the health or safety of recipients or the | ||
possibility that the provider's conduct may result in that serious | ||
threat at any time. | ||
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 immediately if it receives | ||
a vote of two-thirds of all the members elected to each house, as | ||
provided by Section 39, Article III, Texas Constitution. If this | ||
Act does not receive the vote necessary for immediate effect, this | ||
Act takes effect September 1, 2023. |