| 1 | 1 | | 88R1364 AMF-F |
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| 2 | 2 | | By: Hughes S.B. No. 862 |
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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 audit of claims and recovery of overpayments by |
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| 8 | 8 | | Medicaid recovery audit contractors. |
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| 9 | 9 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 10 | 10 | | SECTION 1. Section 531.117, Government Code, is amended to |
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| 11 | 11 | | read as follows: |
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| 12 | 12 | | Sec. 531.117. RECOVERY AUDIT CONTRACTORS. (a) To the |
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| 13 | 13 | | extent required under Section 1902(a)(42), Social Security Act (42 |
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| 14 | 14 | | U.S.C. Section 1396a(a)(42)), the commission shall establish a |
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| 15 | 15 | | program under which the commission contracts with one or more |
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| 16 | 16 | | recovery audit contractors for purposes of identifying |
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| 17 | 17 | | underpayments and overpayments under Medicaid, including under the |
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| 18 | 18 | | Medicaid managed care program, and recovering the overpayments. |
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| 19 | 19 | | (b) The commission's office of inspector general shall |
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| 20 | 20 | | ensure that a recovery audit contractor: |
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| 21 | 21 | | (1) in identifying underpayments and overpayments |
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| 22 | 22 | | under the Medicaid managed care program, identifies both payments |
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| 23 | 23 | | made to a Medicaid managed care organization and payments made by a |
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| 24 | 24 | | Medicaid managed care organization that the organization did not |
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| 25 | 25 | | previously identify in an audit and for which the organization did |
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| 26 | 26 | | not initiate recovery efforts; and |
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| 27 | 27 | | (2) makes efforts to recover identified overpayments. |
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| 28 | 28 | | (c) A Medicaid managed care organization may audit a claim |
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| 29 | 29 | | the organization paid until the first anniversary of the date the |
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| 30 | 30 | | organization paid the claim for purposes of determining whether the |
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| 31 | 31 | | organization made an overpayment and initiating recovery efforts. |
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| 32 | 32 | | (d) Not earlier than the first anniversary of the date a |
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| 33 | 33 | | Medicaid managed care organization paid a claim and not later than |
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| 34 | 34 | | the second anniversary of that date, a recovery audit contractor |
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| 35 | 35 | | may audit the claim, identify whether the organization made an |
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| 36 | 36 | | overpayment, and initiate recovery of any overpayment. The recovery |
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| 37 | 37 | | audit contractor may recover an identified overpayment until the |
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| 38 | 38 | | third anniversary of the date the organization made the |
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| 39 | 39 | | overpayment. |
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| 40 | 40 | | SECTION 2. If before implementing any provision of this Act |
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| 41 | 41 | | a state agency determines that a waiver or authorization from a |
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| 42 | 42 | | federal agency is necessary for implementation of that provision, |
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| 43 | 43 | | the agency affected by the provision shall request the waiver or |
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| 44 | 44 | | authorization and may delay implementing that provision until the |
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| 45 | 45 | | waiver or authorization is granted. |
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| 46 | 46 | | SECTION 3. This Act takes effect September 1, 2023. |
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