| |
| |
|
|
A BILL TO BE ENTITLED
|
|
|
AN ACT
|
|
|
relating to the proof required to impose payment holds in certain |
|
|
cases of alleged fraud by Medicaid providers. |
|
|
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
|
|
SECTION 1. Section 531.102(g)(3), Government Code, is |
|
|
amended to read as follows: |
|
|
(3) On timely written request by a provider subject to |
|
|
a payment hold under Subdivision (2), other than a hold requested by |
|
|
the state's Medicaid fraud control unit, the office shall file a |
|
|
request with the State Office of Administrative Hearings for an |
|
|
expedited administrative hearing regarding the hold not later than |
|
|
the third day after the date the office receives the provider's |
|
|
request. The provider must request an expedited administrative |
|
|
hearing under this subdivision not later than the 10th day after the |
|
|
date the provider receives notice from the office under Subdivision |
|
|
(2). The State Office of Administrative Hearings shall hold the |
|
|
expedited administrative hearing not later than the 45th day after |
|
|
the date the State Office of Administrative Hearings receives the |
|
|
request for the hearing. In a hearing held under this subdivision: |
|
|
(A) the provider and the office are each limited |
|
|
to four hours of testimony, excluding time for responding to |
|
|
questions from the administrative law judge; |
|
|
(B) the provider and the office are each entitled |
|
|
to two continuances under reasonable circumstances; and |
|
|
(C) the office is required to show probable cause |
|
|
that the credible allegation of fraud that is the basis of the |
|
|
payment hold has an indicia of reliability and that continuing to |
|
|
pay the provider presents [an ongoing significant financial risk to |
|
|
the state and] a threat to the integrity of Medicaid due to: |
|
|
(i) an ongoing risk that the alleged fraud |
|
|
could result in the provider or another person receiving an |
|
|
unauthorized benefit of more than $100,000; or |
|
|
(ii) the provider's conduct having resulted |
|
|
in a serious threat to the health or safety of recipients or the |
|
|
possibility that the provider's conduct may result in that serious |
|
|
threat at any time. |
|
|
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 immediately if it receives |
|
|
a vote of two-thirds of all the members elected to each house, as |
|
|
provided by Section 39, Article III, Texas Constitution. If this |
|
|
Act does not receive the vote necessary for immediate effect, this |
|
|
Act takes effect September 1, 2021. |