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Relating to claims and overpayment recoupment processes imposed on health care providers under Medicaid.
The fiscal implications of the bill cannot be determined at this time because it is unknown to what extent changes in overpayment collection methods would result in delayed or reduced revenue.
The Health and Human Services Commission is required to implement a provision of this Act only if the legislature appropriates money to the commission 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 appropriations that are available for that purpose.
Electronic Visit Verification (EVV) is a computer-based system that electronically verifies the occurrence of authorized personal attendant service visits by electronically documenting the precise time a service delivery visit begins and ends. Texas requires EVV for certain Medicaid-funded home and community-based services provided through the Health and Human Services Commission (HHSC) and health plans.
SB 1991 would allow HHSC to recognize a health care provider's proprietary EVV system, whether purchased or developed by the provider, as complying with bill provisions that allow the health care provider to use that system for a period determined by HHSC. This bill would ensure that a health care provider that uses its own proprietary EVV system is reimbursed for the use of that system.
This bill would also require HHSC to develop an open model system that mitigates the administrative burdens identified by providers required to use EVV; allow providers to use emerging technologies; and adopt rules governing data submission and provider reimbursement.
Additionally, SB 1991 would require the executive commissioner to adopt rules that standardize the process by which a managed care organization (MCO) collects alleged overpayments that are made to a health care provider and discovered through an audit or investigation conducted by the MCO secondary to missing EVV information. The MCO would be required to provide written notice of the MCO's intent to recoup overpayments not later than the 30th day after the date an audit is complete and limit the duration of audits to 24 months.
Since this bill does not appear to have a connection to our liberty principles, Texas Action has a neutral stance towards SB 1991.