S.B. No. 2458 aims to enhance the oversight and recovery of Medicaid overpayments by establishing a structured program for recovery audit contractors. The bill amends Section 544.0504 of the Government Code to require the Health and Human Services Commission to contract with recovery audit contractors to identify and recover Medicaid 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 and outlines conditions under which recovery audit contractors may initiate reviews and recovery efforts.

Additionally, the bill mandates that recovery audit contractors must obtain approval from the office of inspector general before initiating a claim review and must wait at least one year after the claim's receipt. It also establishes confidentiality for information obtained during the review process and requires the executive commissioner to adopt rules for appeals related to identified overpayments. The implementation of these changes is contingent upon legislative appropriations, and the act is set to take effect on September 1, 2025.

Statutes affected:
Senate Committee Report: Government Code 544.0504 (Government Code 544)