(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.

Text of section effective on April 01, 2025