Texas § GV.525.0102 - SUBROGATION AND THIRD-PARTY REIMBURSEMENT CONTRACTS

§ GV.525.0102. SUBROGATION AND THIRD-PARTY REIMBURSEMENT CONTRACTS

SUBROGATION AND THIRD-PARTY REIMBURSEMENT CONTRACTS. (a) Except as provided by Subsection (d), the commission shall enter into a contract under which the contractor is authorized on behalf of the commission or a health and human services agency to recover money under a subrogation or third-party reimbursement right the commission or agency holds that arises from payment of medical expenses. The contract must provide that: (1) the commission or agency, as appropriate, shall compensate the contractor based on a percentage of the amount of money the contractor recovers for the commission or agency; and (2) the contractor may represent the commission or agency in a court proceeding to recover money under a subrogation or third-party reimbursement right if: (A) the attorney required by other law to represent the commission or agency in court approves; and (B) the representation is cost-effective and specifically authorized by the commission. (b) The commission shall develop a process to: (1) identify claims for the recovery of money under a subrogation or third-party reimbursement right described by this section; and (2) refer the identified claims to a contractor authorized under this section. (c) A health and human services agency shall cooperate with a contractor authorized under this section on a claim the agency refers to the contractor for recovery. (d) If the commission cannot identify a contractor who is willing to contract with the commission under this section on reasonable terms, the commission: (1) is not required to enter into a contract under Subsection (a); and (2) shall develop and implement alternative policies to ensure the recovery of money under a subrogation or third-party reimbursement right. (e) The commission may allow a state agency other than a health and human services agency to be a party to the contract required by Subsection (a). If the commission allows an additional state agency to be a party to the contract, the commission shall modify the contract as necessary to reflect the services the contractor is to provide to that agency. Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611 ), Sec. 1.01, eff. April 1, 2025. SUBCHAPTER D. PLANNING AND DELIVERY OF HEALTH AND HUMAN SERVICES