BILL ANALYSIS



C.S.S.B. 602
By: Zaffirini, Moncrief (Berlanga, et al.)
04-27-95
Committee Report (Substituted)


BACKGROUND

The Texas Medicaid program has grown from a total budget of $7.5
billion in the 1990-91 biennium to an appropriation of $18.7
billion for the current 1994-95 biennium, including $6.8 billion in
general revenue and $11.7 billion in federal funds.  This growth is
due to federal mandates regarding eligibility expansions, required
services, and provider reimbursement rules.

Lt. Gov. Bob Bullock charged the Senate Committee on Health and
Human Services with the challenging task of developing
recommendations for wholesale reform.  In response the committee
began an intensive investigation that included a public hearing May
31-June 1, 1994, and on-site visits to Medicaid managed care pilot
projects in Texas, to a rural health clinic, and to a
rehabilitation center. On November 29-30, 1994, the House
Committees on Public Health and on Human Services joined the Senate
committee in a second public hearing in which public testimony was
taken. The Senate Committee on Health and Human Services then
adopted the recommendations that are the basis of this legislation.

PURPOSE

S.B. 602, as substituted, would require the development and
implementation of a health care database to detect fraud
perpetrated by a program provider or client and to facilitate
comprehensive analysis of Medicaid data, including prescription
medication data.

RULEMAKING AUTHORITY

It is the committee's opinion that this bill does not grant any
additional rulemaking authority to a state officer, institution,
or agency.

SECTION BY SECTION ANALYSIS

SECTION 1. Amends Article 4413(502), Revised Statutes, by adding
Section 16A, as follows:

Sec. 16A.  MEDICAID DATA COLLECTION SYSTEM. (a) Requires the
Health and Human Services Commission (commission) and each health
and human services agency that administers a part of the state
Medicaid program to jointly develop a system to coordinate and
integrate state Medicaid databases (system) to facilitate the
analysis of Medicaid data and detect fraud.

     (b) Requires the commission, to minimize cost and
     duplication of activities, to assist and coordinate the
     efforts of participating agencies in the development of the
     system and involved in health-related computer database
     activities provided for by legislation enacted by the 74th
     Legislature.

     (c) Requires a state agency that administers any part of the
     state Medicaid program to assist the commission in
     developing the system, on the request of the commissioner of
     health and human services.
     
     (d) Requires the commission to develop the database system
     so as to enable analysis of the use of prescription
     medications, including information relating to Medicaid
     clients for whom more than three medications have been
     prescribed, and the medical effect that denial of Medicaid
     coverage for more than three medications has had on clients.

SECTION 2. Effective date: September 1, 1995.

SECTION 3. Emergency clause.

COMPARISON OF ORIGINAL TO SUBSTITUTE

The substitute, as compared with the engrossed version of the
bill, strengthens the commission s charge to coordinate data
collection efforts among state agencies and to avoid duplication
of effort. In addition, the substitute specifies that database
efforts should be conducted so as to permit complete analysis of
the use of prescription medications, including medical effect.

The substitute also adds a provision requiring the commission to
develop the database system in a manner to enable a complete
analysis of the use of prescription medications.

SUMMARY OF COMMITTEE ACTION

S.B. 602 was considered by the Public Health Committee in a
formal meeting on April 27, 1995. The committee considered a
complete substitute for the bill. The substitute was adopted
without objection. The bill was reported favorably as
substituted, with the recommendation that it do pass and be
printed, by a record vote of 9 Ayes, 0 Nays, 0 PNV, and 0 Absent.