H.B. No. 142         AN ACT   relating to the Health and Human Services Commission's office of   inspector general, the review of certain Medicaid claims, and the   recovery of certain overpayments under Medicaid.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Section 544.0106, Government Code, is amended to   read as follows:          Sec. 544.0106.  PROCUREMENT OF [CONTRACT FOR REVIEW OF   INVESTIGATIVE FINDINGS BY] QUALIFIED EXPERT ON BEHALF OF OFFICE OF   INSPECTOR GENERAL. A qualified expert retained by the commission   on behalf of the office of inspector general is considered an expert   witness for purposes of Section 2151.005 [(a)  If the commission   does not receive any responsive bids under Chapter 2155 on a   competitive solicitation for the services of a qualified expert to   review investigative findings under Section 544.0104 or 544.0105   and the number of contracts to be awarded under this subsection is   not otherwise limited, the commission may negotiate with and award   a contract for the services to a qualified expert on the basis of:                [(1)  the contractor's agreement to a set fee, either as   a range or lump-sum amount; and                [(2)  the contractor's affirmation and the office of   inspector general's verification that the contractor possesses the   necessary occupational licenses and experience].          [(b)  Notwithstanding Sections 2155.083 and 2261.051, a   contract awarded under Subsection (a) is not subject to competitive   advertising and proposal evaluation requirements.]          SECTION 2.  Subchapter C, Chapter 544, Government Code, is   amended by adding Section 544.0115 to read as follows:          Sec. 544.0115.  PERMITTED DISCLOSURE OF CERTAIN   INFORMATION. For purposes of performing the duties of the office of   inspector general under this subchapter, the office may disclose   information obtained in the course of conducting the office's   administrative oversight activities to:                (1)  a federal, state, or local governmental entity,   including:                      (A)  a federal agency or an agency of this state or   another state;                      (B)  the criminal, civil, or administrative   department, division, bureau, or other entity with enforcement or   prosecutorial authority of:                            (i)  this state;                            (ii)  the United States;                            (iii)  another state; or                            (iv)  a local governmental entity of this   state or another state; and                      (C)  a political subdivision of this state; or                (2)  a person authorized by the office to receive the   information.          SECTION 3.  Section 544.0153(b), Government Code, is amended   to read as follows:          (b)  Except as required by federal law, to [To] determine a   health care professional's eligibility to participate as a Medicaid   provider, the office of inspector general may not conduct a   fingerprint-based criminal history record information check of a   health care professional who the office has confirmed under   Subsection (a) is licensed and in good standing. This subsection   does not prohibit the office from conducting a criminal history   record information check of a provider that is required or   appropriate for other reasons, including for conducting an   investigation of fraud, waste, or abuse.          SECTION 4.  Section 544.0202(b), Government Code, is amended   to read as follows:          (b)  The commission shall:                (1)  aggressively publicize successful fraud   prosecutions and fraud-prevention programs through all available   means, including the use of statewide press releases; and                (2)  ensure that the commission or a health and human   services agency maintains and promotes an appropriate   communications system [a toll-free telephone hotline] for   reporting suspected fraud in programs the commission or a health   and human services agency administers.          SECTION 5.  Section 544.0504, Government Code, is amended to   read as follows:          Sec. 544.0504.  RECOVERY AUDIT CONTRACTORS.  (a) To the   extent required under Section 1902(a)(42), Social Security Act (42   U.S.C. Section 1396a(a)(42)), the commission shall establish a   program under which the commission contracts with one or more   recovery audit contractors to:                (1)  identify Medicaid underpayments and overpayments,   including underpayments and overpayments under the Medicaid   managed care program; and                (2)  recover the overpayments.          (b)  An overpayment under Subsection (a)(2) may be recovered   from either the provider or the managed care organization.          (c)  A recovery audit contractor may not:                (1)  initiate a review of a claim unless:                      (A)  the office of inspector general or the   office's designee:                            (i)  determines that the review would be   cost-effective; and                            (ii)  approves the review; and                      (B)  at least one year has elapsed since the date   the claim was received; or                (2)  initiate a recovery effort on a claim if a managed   care organization has notified the office of inspector general that   the organization is auditing the claim.          (d)  On request by a recovery audit contractor or the office   of inspector general, a managed care organization or provider who   is the subject of a review conducted under this section shall submit   to the contractor or office all information necessary to perform   the review not later than the date specified in the request.  All   information and materials obtained under this section are   confidential under Section 544.0259(e).          (e)  The executive commissioner by rule shall adopt a process   for appeals related to overpayments identified by a recovery audit   contractor under this section.          (f)  The commission may contract with a third party to   administer Subsection (b) or the appeals process adopted under   Subsection (e).          (g)  The executive commissioner, in consultation with the   office of inspector general, may adopt rules necessary to implement   this section.          SECTION 6.  The following provisions of the Government Code   are repealed:                (1)  Section 544.0201; and                (2)  Section 544.0252(a).          SECTION 7.  If before implementing any provision of this Act   a state agency determines that a waiver or 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 8.  The Health and Human Services Commission is   required to implement a provision of this Act only if the   legislature appropriates money specifically for that purpose.  If   the legislature does not appropriate money specifically for that   purpose, the commission may, but is not required to, implement a   provision of this Act using other money available to the commission   for that purpose.          SECTION 9.  This Act takes effect September 1, 2025.       ______________________________ ______________________________      President of the Senate Speaker of the House                   I certify that H.B. No. 142 was passed by the House on April   16, 2025, by the following vote:  Yeas 144, Nays 0, 1 present, not   voting; and that the House concurred in Senate amendments to H.B.   No. 142 on May 19, 2025, by the following vote:  Yeas 123, Nays 1, 1   present, not voting.     ______________________________   Chief Clerk of the House               I certify that H.B. No. 142 was passed by the Senate, with   amendments, on May 8, 2025, by the following vote:  Yeas 31, Nays 0.     ______________________________   Secretary of the Senate      APPROVED: __________________                   Date                       __________________                 Governor