Principle Criteria
Free Enterprise
Property Rights
Personal Responsibility
Limited Government
Individual Liberty
Digest
SB 1616 amends the Texas Government Code to improve due process protections in Medicaid payment recovery and recoupment efforts. The bill mandates that managed care organizations (MCOs) provide a minimum 60-day notice to Medicaid providers before initiating any recovery of alleged overpayments, allowing providers time to address potential claim issues. Additionally, HB 159 prohibits MCOs from reassessing medical necessity or non-provider errors in previously authorized claims for equipment, supplies, or services. The bill also directs the Texas Health and Human Services Commission (HHSC) to establish a program contracting recovery audit contractors to identify and recover overpayments under Medicaid, in alignment with federal Social Security Act requirements.
Author (1)
Juan Hinojosa