By: Hughes  S.B. No. 2458          (In the Senate - Filed March 13, 2025; March 25, 2025, read   first time and referred to Committee on Health & Human Services;   April 14, 2025, reported adversely, with favorable Committee   Substitute by the following vote:  Yeas 9, Nays 0; April 14, 2025,   sent to printer.)Click here to see the committee vote     COMMITTEE SUBSTITUTE FOR S.B. No. 2458 By:  Perry     A BILL TO BE ENTITLED   AN ACT     relating to the review 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, 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 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.  The Health and Human Services Commission is   required to implement the changes in law made by this Act to Section   544.0504, Government Code, 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 those changes in law using   other money available to the commission for that purpose.          SECTION 4.  This Act takes effect September 1, 2025.     * * * * *