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 must ask doctors or hospitals to pay back money within 12 months of making a payment. These companies also have to agree on a fee with an auditor before any audit begins. To keep things fair, the companies 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 12 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.