Relating to the Health and Human Services Commission's office of inspector general, the review of certain Medicaid claims, and the recovery of certain overpayments under Medicaid, the official text

H.B. No. 142

AN ACT

relating to the Health and Human Services Commission's office of

inspector general, the review of certain Medicaid claims, and the

recovery of certain overpayments under Medicaid.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Section 544.0106, Government Code, is amended to

read as follows:

Sec. 544.0106. PROCUREMENT OF [CONTRACT FOR REVIEW OF

INVESTIGATIVE FINDINGS BY] QUALIFIED EXPERT ON BEHALF OF OFFICE OF

INSPECTOR GENERAL. A qualified expert retained by the commission

on behalf of the office of inspector general is considered an expert

witness for purposes of Section 2151.005 [(a) If the commission

does not receive any responsive bids under Chapter 2155 on a

competitive solicitation for the services of a qualified expert to

review investigative findings under Section 544.0104 or 544.0105

and the number of contracts to be awarded under this subsection is

not otherwise limited, the commission may negotiate with and award

a contract for the services to a qualified expert on the basis of:

[(1) the contractor's agreement to a set fee, either as

a range or lump-sum amount; and

[(2) the contractor's affirmation and the office of

inspector general's verification that the contractor possesses the

necessary occupational licenses and experience].

[(b) Notwithstanding Sections 2155.083 and 2261.051, a

contract awarded under Subsection (a) is not subject to competitive

advertising and proposal evaluation requirements.]

SECTION 2. Subchapter C, Chapter 544, Government Code, is

amended by adding Section 544.0115 to read as follows:

Sec. 544.0115. PERMITTED DISCLOSURE OF CERTAIN

INFORMATION. For purposes of performing the duties of the office of

inspector general under this subchapter, the office may disclose

information obtained in the course of conducting the office's

administrative oversight activities to:

(1) a federal, state, or local governmental entity,

including:

(A) a federal agency or an agency of this state or

another state;

(B) the criminal, civil, or administrative

department, division, bureau, or other entity with enforcement or

prosecutorial authority of:

(i) this state;

(ii) the United States;

(iii) another state; or

(iv) a local governmental entity of this

state or another state; and

(C) a political subdivision of this state; or

(2) a person authorized by the office to receive the

information.

SECTION 3. Section 544.0153(b), Government Code, is amended

to read as follows:

(b) Except as required by federal law, to [To] determine a

health care professional's eligibility to participate as a Medicaid

provider, the office of inspector general may not conduct a

fingerprint-based criminal history record information check of a

health care professional who the office has confirmed under

Subsection (a) is licensed and in good standing. This subsection

does not prohibit the office from conducting a criminal history

record information check of a provider that is required or

appropriate for other reasons, including for conducting an

investigation of fraud, waste, or abuse.

SECTION 4. Section 544.0202(b), Government Code, is amended

to read as follows:

(b) The commission shall:

(1) aggressively publicize successful fraud

prosecutions and fraud-prevention programs through all available

means, including the use of statewide press releases; and

(2) ensure that the commission or a health and human

services agency maintains and promotes an appropriate

communications system [a toll-free telephone hotline] for

reporting suspected fraud in programs the commission or a health

and human services agency administers.

SECTION 5. 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 6. The following provisions of the Government Code

are repealed:

(1) Section 544.0201; and

(2) Section 544.0252(a).

SECTION 7. 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 8. The Health and Human Services Commission is

required to implement a provision of this Act 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 a

provision of this Act using other money available to the commission

for that purpose.

SECTION 9. This Act takes effect September 1, 2025.

______________________________
______________________________

President of the Senate
Speaker of the House

I certify that H.B. No. 142 was passed by the House on April

16, 2025, by the following vote: Yeas 144, Nays 0, 1 present, not

voting; and that the House concurred in Senate amendments to H.B.

No. 142 on May 19, 2025, by the following vote: Yeas 123, Nays 1, 1

present, not voting.

______________________________

Chief Clerk of the House

I certify that H.B. No. 142 was passed by the Senate, with

amendments, on May 8, 2025, by the following vote: Yeas 31, Nays 0.

______________________________

Secretary of the Senate

APPROVED: __________________

Date

__________________

Governor