The bill amends Section 544.0504 of the Government Code to enhance the oversight and recovery of Medicaid overpayments by recovery audit contractors. It establishes a program requiring the commission to contract with these auditors to identify both underpayments and overpayments, including those related to the Medicaid managed care program. The bill specifies that overpayments can be recovered from either the provider or the managed care organization. Additionally, it sets conditions under which recovery audit contractors can initiate reviews and recovery efforts, ensuring that such actions are cost-effective and approved by the office of inspector general.

Furthermore, the bill mandates that managed care organizations or providers must provide necessary information for reviews upon request, with all obtained materials being confidential. It also requires the executive commissioner to adopt a process for appeals related to identified overpayments and allows for contracting with third parties to administer the appeals process. The implementation of these changes is contingent upon legislative appropriations, and the bill is set to take effect on September 1, 2025.

Statutes affected:
House Committee Report: Government Code 544.0504 (Government Code 544)
Engrossed: Government Code 544.0504 (Government Code 544)