HB 159 — Relating to certain payment recovery and recoupment efforts under Medicaid and the child health plan program.

Summary

Relating to certain payment recovery and recoupment efforts under Medicaid and the child health plan program.

Bill Text

Compared against the Texas statutes as published AI-generated reading aid — verify against the official bill.

This bill amends 2 section(s) of the Texas statutes: Section 544.0502, Government Code, Section 544.0504, Government Code.

• Section 544.0502, Government Code

  a provider required to use electronic visit verification at least → a provider required to use electronic visit verification a provider, regardless of whether the provider is required to use electronic visit verification, a minimum of after the provider has exhausted all rights to an appeal , including by submitting necessary documentation for the claim or resubmitting the claim, (j) A managed care organization or the organization's contracted entity that engages in payment recovery efforts under this section or Section 544.0503, in conducting an audit or other review of a claim for equipment, supplies, or services for which the organization granted prior authorization, may not review: (1) the medical necessity determination; or (2) an error in the claim documentation for the previously approved equipment, supplies, or services, if the error was not made by the provider.

  amended

• Section 544.0504, Government Code

  Medicaid → under Medicaid, including under the Medicaid managed care program,

  amended

Action History

1. February 27, 2025

   Referred to Human Services

2. February 27, 2025

   Read first time

3. November 12, 2024

   Filed

Sponsors

• Richard Peña Raymond · Primary

Subjects