Bills › 91st General Assembly
Relating to managed care organization chargebacks and third-party auditors
Sponsored by Rep. Matthew Rinker (R)
Topics:Health careInsuranceMedicaid
Where it is now
- Done: IntroducedMarch 6, 2025
- Stopped: SubcommitteeDied when the General Assembly ended
- Next: House committeeFunnel: by February 20, 2026
- Next: Passes the House
- Next: Senate committeeFunnel: by March 20, 2026
- Next: Passes the Senate
- Next: To the Governor
- Next: Signed into law
Died when the session ended The 2026 session adjourned on May 3, 2026, the General Assembly’s last regular session. Bills that didn’t pass both chambers died. What’s a funnel?
What’s in it
AI summary Companies that manage Medicaid programs must follow new rules when they ask doctors or hospitals to pay money back. These companies have a set amount of time to request a refund after they have already paid a provider. They must also agree on a fee with an auditor before any audit starts and cannot pay auditors based on how much money they find.1
Read the official explanation
This bill requires a managed care organization (MCO) acting pursuant to a contract with the department of health and human services to administer the medical assistance program to issue a chargeback to a provider within months from the date the MCO provided reimbursement to the provider. The bill requires an MCO to negotiate a fee with a third-party auditor (auditor) prior to the auditor initiating an audit of a provider. An MCO shall not base compensation for an auditor on the percentage of chargebacks identified by the auditor.