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A BILL TO BE ENTITLED
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AN ACT
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relating to the audit of claims and recovery of overpayments by |
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Medicaid recovery audit contractors. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 531.117, Government Code, is amended to |
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read as follows: |
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Sec. 531.117. RECOVERY AUDIT CONTRACTORS. (a) To the |
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extent required under Section 1902(a)(42), Social Security Act (42 |
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U.S.C. Section 1396a(a)(42)), the commission shall establish a |
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program under which the commission contracts with one or more |
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recovery audit contractors for purposes of identifying |
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underpayments and overpayments under Medicaid, including under the |
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Medicaid managed care program, and recovering the overpayments. |
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(b) The commission's office of inspector general shall |
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ensure that a recovery audit contractor: |
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(1) in identifying underpayments and overpayments |
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under the Medicaid managed care program, identifies both payments |
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made to a Medicaid managed care organization and payments made by a |
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Medicaid managed care organization that the organization did not |
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previously identify in an audit and for which the organization did |
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not initiate recovery efforts; and |
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(2) makes efforts to recover identified overpayments. |
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(c) A Medicaid managed care organization may audit a claim |
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the organization paid until the first anniversary of the date the |
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organization paid the claim for purposes of determining whether the |
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organization made an overpayment and initiating recovery efforts. |
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(d) Not earlier than the first anniversary of the date a |
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Medicaid managed care organization paid a claim and not later than |
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the second anniversary of that date, a recovery audit contractor |
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may audit the claim, identify whether the organization made an |
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overpayment, and initiate recovery of any overpayment. The recovery |
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audit contractor may recover an identified overpayment until the |
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third anniversary of the date the organization made the |
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overpayment. |
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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 September 1, 2023. |