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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 544.0504, Government Code, as effective |
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April 1, 2025, is amended to read as follows: |
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Sec. 544.0504. 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 to: |
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(1) identify Medicaid underpayments and overpayments, |
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including underpayments and overpayments under the Medicaid |
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managed care program; and |
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(2) recover the overpayments. |
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(b) A recovery audit contractor may recover an overpayment |
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under Subsection (a)(2) from either the provider or the managed |
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care organization. |
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(c) To avoid duplicative recovery efforts on a claim, a |
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recovery audit contractor shall: |
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(1) notify the office of inspector general or the |
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office's designee prior to initiating a review of a claim under this |
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section; and |
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(2) if directed by the office, exclude a claim. |
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(d) On request by a recovery audit contractor or the office |
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of inspector general, a managed care organization or provider who |
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is the subject of an audit conducted under this section shall submit |
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to the contractor or office all information necessary to perform |
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the audit not later than the date specified in the request. All |
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information and materials obtained under this section are |
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confidential under Section 544.0259(e). |
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(e) The executive commissioner by rule shall adopt a process |
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for appeals related to overpayments identified by a recovery audit |
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contractor under this section. |
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(f) The commission may contract with a third party to |
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administer Subsection (d) or (e). |
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(g) The executive commissioner, in consultation with the |
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office of inspector general, may adopt rules necessary to implement |
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this section. |
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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, 2025. |