Manuel Medicaid Bill Puts A Four-Year Limit On Waste Clawbacks

The text as introduced · 268 words

By: Manuel
H.B. No. 5231

A BILL TO BE ENTITLED

AN ACT

relating to clarity and certainty in the administration and

operation of Medicaid.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Section 32.0231, Human Resources Code, is

amended by adding Subsection (a-1) to read as follows:

(a-1) The commission through the rulemaking process

established by Chapter 2001, Government Code, shall on a

prospective basis determine whether to exclude or limit a benefit

under the medical assistance program, unless the exclusion or

limitation is required by state or federal law.

SECTION 2. Subchapter K, Chapter 544, Government Code, as

effective April 1, 2025, is amended by adding Subsection (j) to

Section 544.0502 to read as follows:

(j) Notwithstanding other law, the office of the inspector

general may not recover under subsection (f) a payment made to a

Medicaid provider as a result of waste or abuse discovered after the

fourth anniversary of the date the payment was made to the provider.

SECTION 3. Section 544.05021, Government Code, as added by

this Act, applies to a payment for which recovery is sought on or

after the effective date of this Act, regardless of the date on

which the payment was made.

SECTION 4. If before implementing any provision of this Act

a state agency determines a waiver or authorization from a federal

agency is necessary for implementation of that provision, the

agency affected by the provision shall request the waiver or

authorization and may delay implementing that provision until the

waiver or authorization is granted.

SECTION 5. This Act takes effect September 1, 2025.