Bill > HB142

This bill modifies several provisions related to the Health and Human Services Commission's Office of Inspector General (OIG) and Medicaid claim reviews. The bill allows a qualified expert retained by the commission to be considered an expert witness, permits the OIG to disclose information obtained during administrative oversight to various governmental entities and authorized persons, and adjusts criminal history record check requirements for healthcare professionals. The bill also changes fraud reporting mechanisms from a specific toll-free hotline to a more flexible "appropriate communications system" and establishes a comprehensive recovery audit contractor program for identifying and recovering Medicaid underpayments and overpayments. The recovery audit contractors are now subject to specific rules, such as only initiating reviews that are cost-effective, approved by the OIG, and at least one year after the original claim, and cannot initiate reviews if a managed care organization is already auditing the claim. The bill provides for an appeals process for overpayments and allows the commission to contract with third parties to administer these processes. The legislation will take effect on September 1, 2025, and implementation is contingent on specific legislative appropriations.

Health and Social Services

https://capitol.texas.gov/BillLookup/History.aspx?LegSess=89R&Bill=HB142