Texas 2025 - 89th Regular

Texas Senate Bill SB1616 Compare Versions

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

Old	New	Differences
1	1	89R223 KKR-D
2	2	By: Hinojosa of Hidalgo S.B. No. 1616
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7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to certain payment recovery and recoupment efforts under
10	10	Medicaid and the child health plan program.
11	11	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	12	SECTION 1. Section 544.0502, Government Code, as effective
13	13	April 1, 2025, is amended by amending Subsection (i) and adding
14	14	Subsection (j) to read as follows:
15	15	(i) The executive commissioner shall adopt rules necessary
16	16	to implement this section, including rules establishing due process
17	17	procedures that a managed care organization must follow when
18	18	engaging in payment recovery efforts as provided by this section.
19	19	In adopting the rules establishing due process procedures, the
20	20	executive commissioner shall require that a managed care
21	21	organization or an organization's contracted entity that engages in
22	22	payment recovery efforts as provided by this section and Section
23	23	544.0503 provide to [a provider required to use electronic visit
24	24	verification]:
25	25	(1) a provider required to use electronic visit
26	26	verification written notice of the organization's intent to recoup
27	27	overpayments in accordance with Section 544.0503; and
28	28	(2) a provider, regardless of whether the provider is
29	29	required to use electronic visit verification, a minimum of [at
30	30	least] 60 days after the provider has exhausted all rights to an
31	31	appeal to cure any defect in a claim, including by submitting
32	32	necessary documentation for the claim or resubmitting the claim,
33	33	before the organization may begin efforts to collect overpayments.
34	34	(j) A managed care organization or the organization's
35	35	contracted entity that engages in payment recovery efforts under
36	36	this section or Section 544.0503, in conducting an audit or other
37	37	review of a claim for equipment, supplies, or services for which the
38	38	organization granted prior authorization, may not review:
39	39	(1) the medical necessity determination; or
40	40	(2) an error in the claim documentation for the
41	41	previously approved equipment, supplies, or services, if the error
42	42	was not made by the provider.
43	43	SECTION 2. Section 544.0504, Government Code, as effective
44	44	April 1, 2025, is amended to read as follows:
45	45	Sec. 544.0504. RECOVERY AUDIT CONTRACTORS. To the extent
46	46	required under Section 1902(a)(42), Social Security Act (42 U.S.C.
47	47	Section 1396a(a)(42)), the commission shall establish a program
48	48	under which the commission contracts with one or more recovery
49	49	audit contractors to identify [Medicaid] underpayments and
50	50	overpayments under Medicaid, including under the Medicaid managed
51	51	care program, and recover the overpayments.
52	52	SECTION 3. If before implementing any provision of this Act
53	53	a state agency determines that a waiver or authorization from a
54	54	federal agency is necessary for implementation of that provision,
55	55	the agency affected by the provision shall request the waiver or
56	56	authorization and may delay implementing that provision until the
57	57	waiver or authorization is granted.
58	58	SECTION 4. This Act takes effect September 1, 2025.