88R1364 AMF-F
By: Harrison H.B. No. 3891
A BILL TO BE ENTITLED
AN ACT
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.