79R4771 RMB-F

By:  Gonzalez Toureilles                                          H.B. No. 3418



A BILL TO BE ENTITLED

AN ACT

relating to audits of providers in the program.                               
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:                        
	SECTION 1.  Subchapter B, Chapter 32, Human Resources Code, 
is amended by adding Section 32.070 to read as follows:
	Sec. 32.070.  AUDITS OF PROVIDERS.  (a)  In this section, 
"provider" means an individual, firm, partnership, corporation, 
agency, association, institution, or other entity that is or was 
approved by the department to provide medical assistance under 
contract or provider agreement with the department.
	(b) The executive commissioner of the Health and Human 
Services Commission shall adopt rules governing the audit of 
providers in the medical assistance program.
	(c)  The rules must:                                                    
		(1)  provide that the agency conducting the audit must 
notify the provider of the impending audit not later than the 
seventh day before the date of the audit;
		(2)  limit the period covered by an audit to one year;                 
		(3)  provide that an audit may not be conducted during 
the first five days of any month;
		(4)  provide that each provider must be audited under 
the same standards and parameters;
		(5)  provide that the agency conducting the audit shall 
allow the provider to correct a clerical error or omission in a 
document required under the medical assistance program if there is 
no indication that the error or omission demonstrates intent to 
commit fraud;
		(6)  permit the provider to produce documentation to 
address any irregularity found during an audit not later than the 
10th day after the date the audit is completed;
		(7)  provide that the agency conducting the audit shall 
deliver a preliminary audit report to the provider not later than 
the 90th day after the date the audit is completed;
		(8)  provide that the agency conducting the audit shall 
deliver the final audit report to the provider not later than the 
180th day after the date the preliminary report is delivered to the 
provider or the date on which a final decision is issued on an 
appeal made under Subdivision (9), whichever is later; and
		(9)  establish an ad hoc peer-review panel, composed of 
providers practicing or doing business in this state appointed by 
the executive commissioner of the Health and Human Services 
Commission, to administer an informal process through which:
			(A)  a provider may obtain an early review of the 
audit report or may appeal an unfavorable audit finding without the 
need to obtain legal counsel; and
			(B)  an unfavorable audit finding that is found to 
be unsubstantiated may be revised or dismissed without need of 
further action by the agency.
	(d)  This section does not apply to an audit conducted by the 
Medicaid fraud control unit of the office of the attorney general.
	SECTION 2.  Not later than January 1, 2006, the executive 
commissioner of the Health and Human Services Commission shall 
adopt rules required by Section 32.070, Human Resources Code, as 
added by this Act.
	SECTION 3.  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 4.  This Act takes effect September 1, 2005.