TX HB3984

Expands the scope of Medicaid recovery audit contractors to identify underpayments and overpayments under both traditional Medicaid and the Medicaid managed care program, with authority to recover overpayments from either providers or managed care organizations

Prohibits recovery audit contractors from initiating claim reviews unless the Office of Inspector General (or designee) determines the review is cost-effective, approves it, and at least one year has elapsed since the claim was received

Bars recovery audit contractors from pursuing recovery on claims already being audited by a managed care organization that has notified the Office of Inspector General

Requires managed care organizations and providers under review to submit all requested information by the specified deadline, with all obtained materials kept confidential

Directs the executive commissioner to adopt rules for an appeals process for overpayments identified by recovery audit contractors, and allows the commission to contract with third parties to administer recovery and appeals

Implementation contingent on legislative appropriation of funds specifically for this purpose, and may be delayed pending any required federal waivers or authorizations; effective date is September 1, 2025