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.