On June 14ththe Governor signed into law SB 1803. It amends Chapter 531 by limiting the Texas Health and Human Services Office of Inspector General’s (HHSC-OIG) ability to implement payment holds, improving providers’ rights to expedited appeals before the State Office of Administrative Hearings, redefining the liability for hearing costs, creating new requirements for HHSC-OIG mandatory preliminary investigations that must be done and documented before holds or full investigations can proceed, adding mandatory requirements for proper expert review of OIG investigations before a determination of overpayment is made and many other measures to curb the unrest caused by the HHSC-OIG reviews, audits and investigations conducted over the last two years. For example, it requires the HHSC-OIG to include in writing to the provider the specific basis for holds, a description of the facts and the supporting evidence, a representative sample of any documents that form the basis for the overpayment hold, the extrapolation methodology, the calculation of the overpayment or debt amount, the amount of damages and penalties if applicable and their rights to appeal. Providers supported this measure in response to what they cited as over-zealous and unfair treatment by the HHSC-OIG. The new limitations, rights and rules are effective September 1, 2013.
