Bill Text: TX HB4192 | 2019-2020 | 86th Legislature | Introduced
Bill Title: Relating to claims and overpayment recoupment processes imposed on health care providers under Medicaid and other public benefits programs.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2019-04-23 - Left pending in committee [HB4192 Detail]
Download: Texas-2019-HB4192-Introduced.html
86R13429 KFF-F | ||
By: Klick | H.B. No. 4192 |
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relating to claims and overpayment recoupment processes imposed on | ||
health care providers under Medicaid and other public benefits | ||
programs. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Section 531.024172, Government Code, is amended | ||
by amending Subsection (g) and adding Subsection (g-1) to read as | ||
follows: | ||
(g) The commission may recognize a health care provider's | ||
proprietary electronic visit verification system, whether | ||
purchased or developed by the provider, as complying with this | ||
section and allow the health care provider to use that system for a | ||
period determined by the commission if the commission determines | ||
that the system: | ||
(1) complies with all necessary data submission, | ||
exchange, and reporting requirements established under this | ||
section; and | ||
(2) meets all other standards and requirements | ||
established under this section[ |
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(g-1) The commission or a managed care organization shall | ||
reimburse a health care provider providing services to a Medicaid | ||
recipient at the same reimbursement rate for the same service | ||
regardless of whether the provider uses the electronic visit | ||
verification system implemented under Subsection (b) or the | ||
provider's own proprietary electronic visit verification system | ||
under Subsection (g). | ||
SECTION 2. Section 531.1131, Government Code, is amended by | ||
adding Subsection (f) to read as follows: | ||
(f) In adopting rules establishing due process procedures | ||
under Subsection (e), the executive commissioner shall require that | ||
a managed care organization or an entity with which the managed care | ||
organization contracts under Section 531.113(a)(2) that engages in | ||
payment recovery efforts in accordance with this section provide: | ||
(1) written notice to a provider of the organization's | ||
intent to recoup overpayments; and | ||
(2) a provider described by Subdivision (1) at least | ||
60 days to cure any defect in a claim before the organization may | ||
begin any efforts to collect overpayments. | ||
SECTION 3. Subchapter C, Chapter 531, Government Code, is | ||
amended by adding Section 531.1135 to read as follows: | ||
Sec. 531.1135. MANAGED CARE ORGANIZATIONS: PROCESS TO | ||
RECOUP CERTAIN OVERPAYMENTS. (a) The executive commissioner shall | ||
adopt rules that standardize the process by which a managed care | ||
organization collects alleged overpayments that are made to a | ||
health care provider and discovered through an audit or | ||
investigation conducted by the organization secondary to missing | ||
electronic visit verification information. In adopting rules under | ||
this section, the executive commissioner shall require that the | ||
managed care organization: | ||
(1) provide written notice of the organization's | ||
intent to recoup overpayments not later than the 30th day after the | ||
date an audit is complete; and | ||
(2) limit the duration of audits to 24 months. | ||
(b) The executive commissioner shall require that the | ||
notice required under this section inform the provider: | ||
(1) of the specific claims and electronic visit | ||
verification transactions that are the basis of the overpayment; | ||
(2) of the process the provider should use to | ||
communicate with the managed care organization to provide | ||
information about the electronic visit verification transactions; | ||
(3) of the provider's option to seek an informal | ||
resolution of the alleged overpayment; | ||
(4) of the process to appeal the determination that an | ||
overpayment was made; and | ||
(5) if the provider intends to respond to the notice, | ||
that the provider must respond not later than the 30th day after the | ||
date the provider receives the notice. | ||
(c) Notwithstanding any other law, a managed care | ||
organization may not attempt to recover an overpayment described by | ||
Subsection (a) until the provider has exhausted all rights to an | ||
appeal. | ||
SECTION 4. If before implementing any provision of this Act | ||
a state agency determines that an additional waiver or additional | ||
authorization from a federal agency is necessary for implementation | ||
of that provision, the agency affected by the provision shall | ||
request the waiver or authorization and may delay implementing that | ||
provision until the waiver or authorization is granted. | ||
SECTION 5. This Act takes effect September 1, 2019. |