Performance Audit Selection Process and Follow-Up

Sec. 540.0154. PERFORMANCE AUDIT SELECTION PROCESS AND FOLLOW-UP. (a) To improve the commission's processes for performance audits of managed care organizations, the commission shall: (1) document the process by which the commission selects organizations to audit; (2) include previous audit coverage as a risk factor in selecting organizations to audit; and (3) prioritize the highest risk organizations to audit. (b) To verify that managed care organizations correct negative performance audit findings, the commission shall: (1) establish a process to: (A) document how the commission follows up on those findings; and (B) verify that organizations implement performance audit recommendations; and (2) establish and implement policies and procedures to: (A) determine under what circumstances the commission must issue a corrective action plan to an organization based on a performance audit; and (B) follow up on the organization's implementation of the plan. Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.