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.
Sponsorship: Partisan Bill (Republican 1)
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 | |
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| 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. | ||
