89R15279 CMO-D
By: Hughes S.B. No. 2458
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 544.0504, Government Code, as effective
April 1, 2025, is amended to read as follows:
Sec. 544.0504. 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 to:
(1) identify Medicaid underpayments and overpayments,
including underpayments and overpayments under the Medicaid
managed care program; and
(2) recover the overpayments.
(b) A recovery audit contractor may recover an overpayment
under Subsection (a)(2) from either the provider or the managed
care organization.
(c) To avoid duplicative recovery efforts on a claim, a
recovery audit contractor shall:
(1) notify the office of inspector general or the
office's designee prior to initiating a review of a claim under this
section; and
(2) if directed by the office, exclude a claim.
(d) On request by a recovery audit contractor or the office
of inspector general, a managed care organization or provider who
is the subject of an audit conducted under this section shall submit
to the contractor or office all information necessary to perform
the audit not later than the date specified in the request. All
information and materials obtained under this section are
confidential under Section 544.0259(e).
(e) The executive commissioner by rule shall adopt a process
for appeals related to overpayments identified by a recovery audit
contractor under this section.
(f) The commission may contract with a third party to
administer Subsection (d) or (e).
(g) The executive commissioner, in consultation with the
office of inspector general, may adopt rules necessary to implement
this section.
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, 2025.