Bill > SB1616

This bill modifies rules related to payment recovery and recoupment efforts in Texas Medicaid programs, focusing on protections for healthcare providers. Specifically, the bill requires managed care organizations to provide written notice to providers about potential overpayment recoupments and extends the period providers have to address claim deficiencies to at least 60 days after exhausting all appeal rights. The bill also limits recovery audit contractors from reviewing medical necessity determinations or provider documentation errors for previously authorized equipment, supplies, or services. Additionally, the bill expands the state's recovery audit program to explicitly include the Medicaid managed care program when identifying and recovering underpayments and overpayments. The changes are designed to create more transparent and fair processes for providers when managed care organizations seek to recover payments, providing additional time and procedural safeguards. The bill is set to take effect on September 1, 2025, and allows state agencies to seek federal waivers if needed for implementation.

Health and Social Services

https://capitol.texas.gov/BillLookup/History.aspx?LegSess=89R&Bill=SB1616