Texas Human Resources Code

§ 32.0705 — EXTERNAL AUDITS OF CERTAIN MEDICAID CONTRACTORS BASED ON RISK

HR § 32.0705Title 2. HUMAN SERVICES AND PROTECTIVE SERVICES IN GENERAL · Part C. ASSISTANCE PROGRAMS · Ch. 32. MEDICAL ASSISTANCE PROGRAM · Art. B. ADMINISTRATIVE PROVISIONS

Statute text

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(a)In this section, "Medicaid contractor" means an entity that:

(1)is not a health and human services agency as defined by Section 521.0001, Government Code; and

(2)under a contract with the commission or otherwise on behalf of the commission, performs one or more administrative services in relation to the commission's operation of Medicaid, such as claims processing, utilization review, client enrollment, provider enrollment, quality monitoring, or payment of claims.

(b)The commission shall contract with an independent auditor to perform annual independent external financial and performance audits of any Medicaid contractor used in the commission's operation of Medicaid. The commission regularly shall review the Medicaid contracts and ensure that:

(1)the frequency and extent of audits of a Medicaid contractor under this section are based on the amount of risk to the state involved in the administrative services being performed by the contractor;

(2)audit procedures related to financial audits and performance audits are used consistently in audits under this section; and

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Legislative history

Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 2.88, eff. April 1, 2025.