89R15279 CMO-D     By: Hughes S.B. No. 2458       A BILL TO BE ENTITLED   AN ACT   relating to the audit of claims and recovery of overpayments by   Medicaid recovery audit contractors.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Section 544.0504, Government Code, as effective   April 1, 2025, 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)  A recovery audit contractor may recover an overpayment   under Subsection (a)(2) from either the provider or the managed   care organization.          (c)  To avoid duplicative recovery efforts on a claim, a   recovery audit contractor shall:                (1)  notify the office of inspector general or the   office's designee prior to initiating a review of a claim under this   section; and                (2)  if directed by the office, exclude a 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 an audit conducted under this section shall submit   to the contractor or office all information necessary to perform   the audit 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 (d) or (e).          (g)  The executive commissioner, in consultation with the   office of inspector general, may adopt rules necessary to implement   this section.          SECTION 2.  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 3.  This Act takes effect September 1, 2025.