Texas 2019 - 86th Regular

Texas Senate Bill SB1483 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	86R9790 JG-D
2	2	By: Hinojosa S.B. No. 1483
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the proof required to impose payment holds in certain
8	8	cases of alleged fraud by Medicaid providers.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Sections 531.102(g)(2) and (3), Government Code,
11	11	are amended to read as follows:
12	12	(2) As authorized under state and federal law, and
13	13	except as provided by Subdivisions (8) and (9), the office shall
14	14	impose without prior notice a payment hold on claims for
15	15	reimbursement submitted by a provider only to compel production of
16	16	records, when requested by the state's Medicaid fraud control unit,
17	17	or on the determination by the office that a credible allegation of
18	18	fraud exists, subject to Subsections (l) and (m), as applicable.
19	19	The payment hold is a serious enforcement tool that the office
20	20	imposes to mitigate ongoing financial risk to the state. A payment
21	21	hold imposed under this subdivision takes effect immediately. The
22	22	office must notify the provider of the payment hold in accordance
23	23	with 42 C.F.R. Section 455.23(b) and, except as provided by that
24	24	regulation, not later than the fifth day after the date the office
25	25	imposes the payment hold. In addition to the requirements of 42
26	26	C.F.R. Section 455.23(b), the notice of payment hold provided under
27	27	this subdivision must also include:
28	28	(A) the specific basis for the hold, including
29	29	identification of the claims supporting the allegation at that
30	30	point in the investigation, a representative sample of any
31	31	documents that form the basis for the hold, and a detailed summary
32	32	of the office's evidence relating to the allegation;
33	33	(B) a description of administrative and judicial
34	34	due process rights and remedies, including the provider's option to
35	35	seek informal resolution, the provider's right to seek a formal
36	36	administrative appeal hearing, or that the provider may seek both;
37	37	and
38	38	(C) a detailed timeline for the provider to
39	39	pursue the rights and remedies described in Paragraph (B).
40	40	(3) On timely written request by a provider subject to
41	41	a payment hold under Subdivision (2), other than a hold requested by
42	42	the state's Medicaid fraud control unit, the office shall file a
43	43	request with the State Office of Administrative Hearings for an
44	44	expedited administrative hearing regarding the hold not later than
45	45	the third day after the date the office receives the provider's
46	46	request. The provider must request an expedited administrative
47	47	hearing under this subdivision not later than the 10th day after the
48	48	date the provider receives notice from the office under Subdivision
49	49	(2). The State Office of Administrative Hearings shall hold the
50	50	expedited administrative hearing not later than the 45th day after
51	51	the date the State Office of Administrative Hearings receives the
52	52	request for the hearing. In a hearing held under this subdivision:
53	53	(A) the provider and the office are each limited
54	54	to four hours of testimony, excluding time for responding to
55	55	questions from the administrative law judge;
56	56	(B) the provider and the office are each entitled
57	57	to two continuances under reasonable circumstances; and
58	58	(C) the office is required to show probable cause
59	59	that the credible allegation of fraud that is the basis of the
60	60	payment hold has an indicia of reliability and that continuing to
61	61	pay the provider presents [an ongoing significant financial risk to
62	62	the state and] a threat to the integrity of Medicaid due to:
63	63	(i) an ongoing significant financial risk
64	64	to the state that may result in the loss of $100,000 or more; or
65	65	(ii) a high probability that a serious
66	66	threat to the health or safety of a recipient exists or may develop
67	67	as a result of the provider's conduct.
68	68	SECTION 2. If before implementing any provision of this Act
69	69	a state agency determines that a waiver or authorization from a
70	70	federal agency is necessary for implementation of that provision,
71	71	the agency affected by the provision shall request the waiver or
72	72	authorization and may delay implementing that provision until the
73	73	waiver or authorization is granted.
74	74	SECTION 3. This Act takes effect immediately if it receives
75	75	a vote of two-thirds of all the members elected to each house, as
76	76	provided by Section 39, Article III, Texas Constitution. If this
77	77	Act does not receive the vote necessary for immediate effect, this
78	78	Act takes effect September 1, 2019.