Bill > SB2458

This bill modifies the rules for Medicaid recovery audit contractors (RACs) in Texas, establishing a more structured process for identifying and recovering underpayments and overpayments in Medicaid programs, including managed care. The bill requires that RACs can only initiate a claim review if the office of inspector general determines it would be cost-effective and approves the review, and only after at least one year has passed since the claim was received. RACs are also prohibited from initiating a recovery effort if a managed care organization is already auditing the claim. The bill mandates that providers and managed care organizations must submit requested information for reviews, and allows overpayment recovery from either the provider or the managed care organization. Additionally, the bill requires the executive commissioner to establish an appeals process for overpayments and allows the commission to contract with a third party to administer the appeals or recovery process. The bill will take effect on September 1, 2025, and its implementation is contingent on specific legislative appropriations, with the Health and Human Services Commission having the option to implement changes using existing funds if specific appropriations are not made.

Health and Social Services

https://capitol.texas.gov/BillLookup/History.aspx?LegSess=89R&Bill=SB2458