Texas Administrative Code
Title 1 - ADMINISTRATION
Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 353 - MEDICAID MANAGED CARE
Subchapter Q - PROCESS TO RECOUP CERTAIN OVERPAYMENTS
Section 353.1453 - Due Process Procedures to Recoup an Overpayment Related to an EVV Visit Transaction that Is Not Fraud or Abuse and Limitation on Audit Period
Current through Reg. 49, No. 38; September 20, 2024
(a) In an audit of a provider or FMSA conducted by a managed care organization (MCO), the MCO must limit the review of EVV visit transactions to those that occurred during the 24 months prior to the audit.
(b) If, based on an audit or investigation of a provider or FMSA, an MCO identifies a deficiency related to an EVV visit transaction that is not fraud or abuse and the MCO decides to recoup an overpayment because of the deficiency, the MCO must give the provider or FMSA written notice of the MCO's intent to recoup overpayments not later than the 30th day after the date the audit or investigation is completed.
(c) An MCO must include the following in the written notice required by subsection (b) of this section:
(d) A corrected deficiency is one that a provider or FMSA makes by doing one or both of the following:
(e) An MCO may recoup an overpayment only if a provider or FMSA:
(f) If an MCO determines that a deficiency related to an EVV visit transaction is fraud or abuse, the MCO must comply with § 353.1454 of this subchapter (relating to Due Process Procedures to Recoup an Overpayment Because of a Discovery of Fraud or Abuse).