| 1 | 1 | | 88R6694 BDP-F |
|---|
| 2 | 2 | | By: Hinojosa S.B. No. 731 |
|---|
| 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. Section 531.102(g)(3), Government Code, is |
|---|
| 11 | 11 | | amended to read as follows: |
|---|
| 12 | 12 | | (3) On timely written request by a provider subject to |
|---|
| 13 | 13 | | a payment hold under Subdivision (2), other than a hold requested by |
|---|
| 14 | 14 | | the state's Medicaid fraud control unit, the office shall file a |
|---|
| 15 | 15 | | request with the State Office of Administrative Hearings for an |
|---|
| 16 | 16 | | expedited administrative hearing regarding the hold not later than |
|---|
| 17 | 17 | | the third day after the date the office receives the provider's |
|---|
| 18 | 18 | | request. The provider must request an expedited administrative |
|---|
| 19 | 19 | | hearing under this subdivision not later than the 10th day after the |
|---|
| 20 | 20 | | date the provider receives notice from the office under Subdivision |
|---|
| 21 | 21 | | (2). The State Office of Administrative Hearings shall hold the |
|---|
| 22 | 22 | | expedited administrative hearing not later than the 45th day after |
|---|
| 23 | 23 | | the date the State Office of Administrative Hearings receives the |
|---|
| 24 | 24 | | request for the hearing. In a hearing held under this subdivision: |
|---|
| 25 | 25 | | (A) the provider and the office are each limited |
|---|
| 26 | 26 | | to four hours of testimony, excluding time for responding to |
|---|
| 27 | 27 | | questions from the administrative law judge; |
|---|
| 28 | 28 | | (B) the provider and the office are each entitled |
|---|
| 29 | 29 | | to two continuances under reasonable circumstances; and |
|---|
| 30 | 30 | | (C) the office is required to show probable cause |
|---|
| 31 | 31 | | that the credible allegation of fraud that is the basis of the |
|---|
| 32 | 32 | | payment hold has an indicia of reliability and that continuing to |
|---|
| 33 | 33 | | pay the provider presents [an ongoing significant financial risk to |
|---|
| 34 | 34 | | the state and] a threat to the integrity of Medicaid due to: |
|---|
| 35 | 35 | | (i) an ongoing risk that the alleged fraud |
|---|
| 36 | 36 | | could result in the provider or another person receiving an |
|---|
| 37 | 37 | | unauthorized benefit of more than $100,000; or |
|---|
| 38 | 38 | | (ii) the provider's conduct having resulted |
|---|
| 39 | 39 | | in a serious threat to the health or safety of recipients or the |
|---|
| 40 | 40 | | possibility that the provider's conduct may result in that serious |
|---|
| 41 | 41 | | threat at any time. |
|---|
| 42 | 42 | | SECTION 2. If before implementing any provision of this Act |
|---|
| 43 | 43 | | a state agency determines that a waiver or authorization from a |
|---|
| 44 | 44 | | federal agency is necessary for implementation of that provision, |
|---|
| 45 | 45 | | the agency affected by the provision shall request the waiver or |
|---|
| 46 | 46 | | authorization and may delay implementing that provision until the |
|---|
| 47 | 47 | | waiver or authorization is granted. |
|---|
| 48 | 48 | | SECTION 3. This Act takes effect immediately if it receives |
|---|
| 49 | 49 | | a vote of two-thirds of all the members elected to each house, as |
|---|
| 50 | 50 | | provided by Section 39, Article III, Texas Constitution. If this |
|---|
| 51 | 51 | | Act does not receive the vote necessary for immediate effect, this |
|---|
| 52 | 52 | | Act takes effect September 1, 2023. |
|---|