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A BILL TO BE ENTITLED
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AN ACT
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relating to the proof required to impose payment holds in certain |
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cases of alleged fraud by Medicaid providers. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 531.102(g)(3), Government Code, is |
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amended to read as follows: |
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(3) On timely written request by a provider subject to |
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a payment hold under Subdivision (2), other than a hold requested by |
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the state's Medicaid fraud control unit, the office shall file a |
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request with the State Office of Administrative Hearings for an |
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expedited administrative hearing regarding the hold not later than |
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the third day after the date the office receives the provider's |
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request. The provider must request an expedited administrative |
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hearing under this subdivision not later than the 10th day after the |
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date the provider receives notice from the office under Subdivision |
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(2). The State Office of Administrative Hearings shall hold the |
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expedited administrative hearing not later than the 45th day after |
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the date the State Office of Administrative Hearings receives the |
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request for the hearing. In a hearing held under this subdivision: |
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(A) the provider and the office are each limited |
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to four hours of testimony, excluding time for responding to |
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questions from the administrative law judge; |
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(B) the provider and the office are each entitled |
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to two continuances under reasonable circumstances; and |
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(C) the office is required to show probable cause |
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that the credible allegation of fraud that is the basis of the |
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payment hold has an indicia of reliability and that continuing to |
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pay the provider presents [an ongoing significant financial risk to |
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the state and] a threat to the integrity of Medicaid due to: |
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(i) an ongoing risk that the alleged fraud |
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could result in the provider or another person receiving an |
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unauthorized benefit of more than $100,000; or |
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(ii) the provider's conduct having resulted |
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in a serious threat to the health or safety of recipients or the |
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possibility that the provider's conduct may result in that serious |
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threat at any time. |
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SECTION 2. If before implementing any provision of this Act |
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a state agency determines that a waiver or authorization from a |
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federal agency is necessary for implementation of that provision, |
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the agency affected by the provision shall request the waiver or |
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authorization and may delay implementing that provision until the |
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waiver or authorization is granted. |
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SECTION 3. This Act takes effect immediately if it receives |
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a vote of two-thirds of all the members elected to each house, as |
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provided by Section 39, Article III, Texas Constitution. If this |
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Act does not receive the vote necessary for immediate effect, this |
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Act takes effect September 1, 2023. |