Bill > HB3984

This bill amends the Texas Government Code to enhance the regulation of Medicaid recovery audit contractors (RACs), which are entities responsible for identifying and recovering improper payments in the Medicaid system. The bill establishes new rules for how these contractors can review and pursue claims, including requiring approval from the office of inspector general before initiating a review, waiting at least one year after a claim is received, and preventing reviews if a managed care organization is already auditing the claim. The legislation allows overpayments to be recovered from either healthcare providers or managed care organizations, mandates that providers and organizations must submit requested information for reviews, and requires the executive commissioner to create an appeals process for challenged overpayments. The bill also includes provisions allowing the Health and Human Services Commission to contract with third parties to administer the recovery and appeals processes. Implementation of the bill is contingent on specific legislative appropriations, and the bill is set to take effect on September 1, 2025, with a provision that allows for delayed implementation if federal waivers or authorizations are needed.

Health and Social Services

https://capitol.texas.gov/BillLookup/History.aspx?LegSess=89R&Bill=HB3984