Texas SB1616 amends Medicaid and child health plan program payment recovery rules, requiring due process and prohibiting certain reviews.

Texas SB1616 modifies the Texas Government Code to update Medicaid and child health plan program payment recovery rules. It mandates that the executive commissioner adopt rules establishing due process procedures for managed care organizations and their contractors when engaging in payment recovery efforts. The bill also prohibits these organizations from reviewing the medical necessity determination or errors in claim documentation for equipment, supplies, or services if the error was not made by the provider. The changes take effect September 1, 2025.

Texas SB1616 amends Medicaid and child health plan program payment recovery rules, requiring due process and prohibiting certain reviews.

Texas SB1616 modifies the Texas Government Code to update Medicaid and child health plan program payment recovery rules. It mandates that the executive commissioner adopt rules establishing due process procedures for managed care organizations and their contractors when engaging in payment recovery efforts. The bill also prohibits these organizations from reviewing the medical necessity determination or errors in claim documentation for equipment, supplies, or services if the error was not made by the provider. The changes take effect September 1, 2025.