| 1 | 1 | | 88R13391 KKR-D |
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| 2 | 2 | | By: Hinojosa S.B. No. 2055 |
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| 3 | 3 | | |
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| 4 | 4 | | |
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| 5 | 5 | | A BILL TO BE ENTITLED |
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| 6 | 6 | | AN ACT |
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| 7 | 7 | | relating to the process for recovering overpayments under Medicaid. |
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| 8 | 8 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 9 | 9 | | SECTION 1. Section 531.1131(f), Government Code, is amended |
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| 10 | 10 | | to read as follows: |
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| 11 | 11 | | (f) In adopting rules establishing due process procedures |
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| 12 | 12 | | under Subsection (e), the executive commissioner shall require that |
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| 13 | 13 | | a managed care organization or an entity with which the managed care |
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| 14 | 14 | | organization contracts under Section 531.113(a)(2) that engages in |
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| 15 | 15 | | payment recovery efforts in accordance with this section and |
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| 16 | 16 | | Section 531.1135 provide: |
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| 17 | 17 | | (1) written notice to a provider required to use |
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| 18 | 18 | | electronic visit verification of the organization's intent to |
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| 19 | 19 | | recoup overpayments in accordance with Section 531.1135; and |
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| 20 | 20 | | (2) any [a] provider [described by Subdivision (1)] at |
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| 21 | 21 | | least 60 days after the provider has exhausted all rights to an |
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| 22 | 22 | | appeal to cure any defect in a claim, including by submitting |
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| 23 | 23 | | necessary documentation for the claim or resubmitting the claim, |
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| 24 | 24 | | before the organization may begin any efforts to collect |
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| 25 | 25 | | overpayments. |
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| 26 | 26 | | SECTION 2. If before implementing any provision of this Act |
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| 27 | 27 | | a state agency determines that a waiver or authorization from a |
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| 28 | 28 | | federal agency is necessary for implementation of that provision, |
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| 29 | 29 | | the agency affected by the provision shall request the waiver or |
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| 30 | 30 | | authorization and may delay implementing that provision until the |
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| 31 | 31 | | waiver or authorization is granted. |
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| 32 | 32 | | SECTION 3. This Act takes effect September 1, 2023. |
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