By Delisi H.B. No. 2212
75R3447 KKA-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to reduction of overpayments in the state Medicaid
1-3 program.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. AMENDMENT. Subchapter B, Chapter 32, Human
1-6 Resources Code, is amended by adding Sections 32.043-32.045 to read
1-7 as follows:
1-8 Sec. 32.043. DUAL MEDICAID AND MEDICARE COVERAGE. (a) At
1-9 least annually the department shall identify each individual
1-10 receiving medical assistance under the medical assistance program
1-11 who is eligible to receive similar assistance under the Medicare
1-12 program.
1-13 (b) The department shall analyze claims submitted for
1-14 payment for a service provided under the medical assistance program
1-15 to an individual identified under Subsection (a) to ensure that
1-16 payment is not made under the medical assistance program if the
1-17 service is covered for the individual under the Medicare program.
1-18 Sec. 32.044. MISDIRECTED BILLING. To the extent authorized
1-19 by federal law, the department shall develop a procedure for:
1-20 (1) matching claims for payment for medical assistance
1-21 provided under the medical assistance program against data
1-22 available from other entities, including the Veterans
1-23 Administration and nursing facilities, to determine alternative
1-24 responsibility for payment of the claims; and
2-1 (2) ensuring that the appropriate entity bears the
2-2 cost of a claim.
2-3 Sec. 32.045. ENHANCED REIMBURSEMENT. The department shall
2-4 develop a procedure for:
2-5 (1) identifying each service provided under the
2-6 medical assistance program for which the state is eligible to
2-7 receive enhanced reimbursement of costs from the federal
2-8 government; and
2-9 (2) ensuring that the state seeks the highest level of
2-10 federal reimbursement available for each service provided.
2-11 SECTION 2. DETERMINATION OF ELIGIBILITY FOR ENHANCED
2-12 REIMBURSEMENT. (a) The Texas Department of Health shall identify
2-13 services provided under the state Medicaid program for the period
2-14 beginning December 31, 1989, and ending immediately before the
2-15 effective date of this Act for which the state was eligible but did
2-16 not receive enhanced reimbursement of costs at a 90 percent rate
2-17 from the federal government.
2-18 (b) For the period specified in Subsection (a) of this
2-19 section, the Texas Department of Health shall seek from the federal
2-20 government all reimbursements to which the state is entitled.
2-21 SECTION 3. REVIEW OF SERVICE PROVIDER BILLING PRACTICES.
2-22 (a) The Texas Department of Health shall conduct an automated
2-23 review of physician, laboratory, and radiology services to
2-24 identify improper billing practices designed to inflate a service
2-25 provider's claim for payment for services provided under the state
2-26 Medicaid program.
2-27 (b) After completing the review required by Subsection (a)
3-1 of this section, the Texas Department of Health shall require the
3-2 entity that administers the state Medicaid program on behalf of the
3-3 department to modify the entity's claims processing and monitoring
3-4 procedures and computer technology as necessary to prevent improper
3-5 billing by service providers.
3-6 SECTION 4. STATE MEDICAID PLAN AMENDMENT; LIMITATION ON
3-7 BENEFITS. (a) As soon as possible after the effective date of
3-8 this Act, the Health and Human Services Commission shall submit an
3-9 amendment to the state's Medicaid plan authorizing the state to
3-10 limit payment under the state Medicaid program of Medicare
3-11 deductible and co-insurance amounts associated with a service for a
3-12 person entitled to receive both Medicaid and Medicare benefits to
3-13 the amount that the state would have paid for the service under the
3-14 state Medicaid program.
3-15 (b) On receipt of approval of the amendment, the Health and
3-16 Human Services Commission shall ensure that the payments described
3-17 by Subsection (a) of this section are limited as authorized by the
3-18 amendment.
3-19 SECTION 5. EMERGENCY. The importance of this legislation
3-20 and the crowded condition of the calendars in both houses create an
3-21 emergency and an imperative public necessity that the
3-22 constitutional rule requiring bills to be read on three several
3-23 days in each house be suspended, and this rule is hereby suspended,
3-24 and that this Act take effect and be in force from and after its
3-25 passage, and it is so enacted.