Bill > HB159

This bill modifies Texas state law regarding payment recovery and recoupment efforts in Medicaid and the child health plan program, focusing on how managed care organizations (MCOs) can audit and recover overpayments. The bill requires MCOs to provide providers with written notice of intent to recoup overpayments and gives providers at least 60 days after exhausting all appeal rights to cure claim defects, such as submitting additional documentation or resubmitting claims. Importantly, when an MCO conducts an audit for previously authorized equipment, supplies, or services, they are prohibited from reviewing the medical necessity determination or challenging documentation errors not made by the provider. The bill also expands the state's recovery audit contractor program to explicitly include identifying and recovering underpayments and overpayments in the Medicaid managed care program. If federal waivers are needed to implement any provision, the relevant state agency can request them and delay implementation until authorization is granted. The bill is set to take effect on September 1, 2025, and aims to provide more protection and due process for healthcare providers during payment recovery efforts.

Health and Social Services

https://capitol.texas.gov/BillLookup/History.aspx?LegSess=89R&Bill=HB159