The bill amends Texas Medicaid laws to enhance administrative remedies for fraud and abuse violations. It introduces provisions allowing the commission to award individuals who report Medicaid fraud or abuse, with a maximum award of five percent of the recovered remedy. The commission will determine the award amount based on the significance of the disclosure and the individual's involvement in the fraudulent activity. Additionally, the bill redefines key terms, expands the list of violations and penalties, and establishes that each day a violation occurs counts as a separate violation, particularly emphasizing protections for vulnerable populations.

Furthermore, the bill modifies procedural requirements related to violations and remedies assessed by the commission. It mandates a detailed written notice to individuals charged with violations, which must include a summary of facts, a recommended remedy, and available due process remedies. The response timeline for individuals is extended from 10 to 30 days, and the process for informal reviews and hearings is clarified. The bill also repeals certain provisions, ensures individuals are not liable for both civil and administrative remedies for the same act, and specifies that the amended provisions apply only to violations occurring after the effective date of September 1, 2025. Additionally, it allows state agencies to seek necessary federal waivers for implementation.

Statutes affected:
Introduced: Human Resources Code 32.039, Human Resources Code 32.0391, Human Resources Code 36.002, Human Resources Code 36.006 (Human Resources Code 32, Human Resources Code 36)
House Committee Report: Human Resources Code 32.039, Human Resources Code 32.0391, Human Resources Code 36.006 (Human Resources Code 32, Human Resources Code 36)