TX SB2458

Expands Medicaid recovery audit contractor authority to identify underpayments and overpayments within the Medicaid managed care program, allowing overpayments to be recovered from either providers or managed care organizations

Prohibits recovery audit contractors from initiating claim reviews unless the Office of Inspector General 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 efforts on claims that managed care organizations have notified the Office of Inspector General they are already auditing

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

Directs the executive commissioner to adopt rules establishing an appeals process for overpayment disputes, and implementation is contingent on legislative appropriation of funds; effective September 1, 2025