Texas HB159 amends Medicaid and child health plan program payment recovery and recoupment efforts.

Texas HB159 amends the Government Code to establish due process procedures for Medicaid and child health plan program payment recovery and recoupment efforts. It requires managed care organizations to provide written notice to providers before recouping overpayments and mandates a 60-day waiting period after a provider has exhausted appeal rights. The bill also restricts audits to equipment, supplies, or services for which prior authorization was granted, prohibiting reviews of medical necessity determinations or claim documentation errors not made by the provider.

Texas HB159 amends Medicaid and child health plan program payment recovery and recoupment efforts.

Texas HB159 amends the Government Code to establish due process procedures for Medicaid and child health plan program payment recovery and recoupment efforts. It requires managed care organizations to provide written notice to providers before recouping overpayments and mandates a 60-day waiting period after a provider has exhausted appeal rights. The bill also restricts audits to equipment, supplies, or services for which prior authorization was granted, prohibiting reviews of medical necessity determinations or claim documentation errors not made by the provider.