(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 managed care organizations to audit;
(2) include previous audit coverage as a risk factor in selecting managed care organizations to audit; and
(3) prioritize the highest risk managed care 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 negative performance audit findings; and
(B) verify that managed care 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 a managed care organization based on a performance audit; and
(B) follow up on the managed care organization’s implementation of the corrective action plan.

Text of section effective until April 01, 2025