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This bill would establish procedure on how the Health and Human Services Commission selects managed care organizations (MCO) to audit, as well as require the commission to periodically audit pharmacy benefit managers that contract with MCOs or require the MCO to audit the pharmacy benefit managers. The bill would also establish a monitoring process in the Medicaid and CHIP services department to strengthen the commission’s process for collecting shared profits from MCOs. The bill would also establish procedures for the security and processing controls over IT systems.
The bill also adds requirements for the verification of reimbursement of certain claims using an electronic visit verification system. These requirements include information requirements for verification of Medicaid patients being reimbursed for personal care services or attendant care services, including services under the Transformation 1115 Waiver. The bill also requires that HHSC implement such a system in accordance with Section 531.024172, Government Code.