Texas 2025 - 89th Regular

Texas Senate Bill SB2458 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
	1	+	89R15279 CMO-D
1	2		By: Hughes S.B. No. 2458
2		-	(In the Senate - Filed March 13, 2025; March 25, 2025, read
3		-	first time and referred to Committee on Health & Human Services;
4		-	April 14, 2025, reported adversely, with favorable Committee
5		-	Substitute by the following vote: Yeas 9, Nays 0; April 14, 2025,
6		-	sent to printer.)
7		-	Click here to see the committee vote
8		-	COMMITTEE SUBSTITUTE FOR S.B. No. 2458 By: Perry
9	3
10	4
11	5
12	6
13	7		A BILL TO BE ENTITLED
14	8		AN ACT
15		-	relating to the ~~review~~ of claims and recovery of overpayments by
	9	+	relating to the audit of claims and recovery of overpayments by
16	10		Medicaid recovery audit contractors.
17	11		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
18		-	SECTION 1. Section 544.0504, Government Code, ~~is amended to~~
19		-	read as follows:
	12	+	SECTION 1. Section 544.0504, Government Code, as effective
	13	+	April 1, 2025, is amended to read as follows:
20	14		Sec. 544.0504. RECOVERY AUDIT CONTRACTORS. (a) To the
21	15		extent required under Section 1902(a)(42), Social Security Act (42
22	16		U.S.C. Section 1396a(a)(42)), the commission shall establish a
23	17		program under which the commission contracts with one or more
24	18		recovery audit contractors to:
25	19		(1) identify Medicaid underpayments and overpayments,
26	20		including underpayments and overpayments under the Medicaid
27	21		managed care program; and
28	22		(2) recover the overpayments.
29		-	(b) An overpayment under Subsection (a)(2) may be recovered
30		-	from either the provider or the managed care organization.
31		-	(c) A recovery audit contractor may not:
32		-	(1) initiate a review of a claim unless:
33		-	(A) the office of inspector general or the
34		-	office's designee:
35		-	(i) determines that the review would be
36		-	cost-effective; and
37		-	(ii) approves the review; and
38		-	(B) at least one year has elapsed since the date
39		-	the claim was received; or
40		-	(2) initiate a recovery effort on a claim if a managed
41		-	care organization has notified the office of inspector general that
42		-	the organization is auditing the claim.
	23	+	(b) A recovery audit contractor may recover an overpayment
	24	+	under Subsection (a)(2) from either the provider or the managed
	25	+	care organization.
	26	+	(c) To avoid duplicative recovery efforts on a claim, a
	27	+	recovery audit contractor shall:
	28	+	(1) notify the office of inspector general or the
	29	+	office's designee prior to initiating a review of a claim under this
	30	+	section; and
	31	+	(2) if directed by the office, exclude a claim.
43	32		(d) On request by a recovery audit contractor or the office
44	33		of inspector general, a managed care organization or provider who
45		-	is the subject of ~~a review~~ conducted under this section shall submit
	34	+	is the subject of an audit conducted under this section shall submit
46	35		to the contractor or office all information necessary to perform
47		-	the ~~review~~ not later than the date specified in the request. All
	36	+	the audit not later than the date specified in the request. All
48	37		information and materials obtained under this section are
49	38		confidential under Section 544.0259(e).
50	39		(e) The executive commissioner by rule shall adopt a process
51	40		for appeals related to overpayments identified by a recovery audit
52	41		contractor under this section.
53	42		(f) The commission may contract with a third party to
54		-	administer Subsection (b) or the appeals process adopted under
55		-	Subsection (e).
	43	+	administer Subsection (d) or (e).
56	44		(g) The executive commissioner, in consultation with the
57	45		office of inspector general, may adopt rules necessary to implement
58	46		this section.
59	47		SECTION 2. If before implementing any provision of this Act
60	48		a state agency determines that a waiver or authorization from a
61	49		federal agency is necessary for implementation of that provision,
62	50		the agency affected by the provision shall request the waiver or
63	51		authorization and may delay implementing that provision until the
64	52		waiver or authorization is granted.
65		-	SECTION 3. The Health and Human Services Commission is
66		-	required to implement the changes in law made by this Act to Section
67		-	544.0504, Government Code, only if the legislature appropriates
68		-	money specifically for that purpose. If the legislature does not
69		-	appropriate money specifically for that purpose, the commission
70		-	may, but is not required to, implement those changes in law using
71		-	other money available to the commission for that purpose.
72		-	SECTION 4. This Act takes effect September 1, 2025.
73		-	* * * * *
	53	+	SECTION 3. This Act takes effect September 1, 2025.