SRC-DBM H.B. 875 76(R)   BILL ANALYSIS


Senate Research Center   H.B. 875
By: Maxey (Zaffirini)
Human Services
4/26/1999
Engrossed


DIGEST 

The Office of Investigations and Enforcement (OIE) was created within the
Health and Human Services Commission (commission)  by Senate Bill 30 during
the 1997 Texas Legislature to investigate recipient and provider Medicaid
fraud.  Recipient fraud occurs when an ineligible individual receives
Medicaid services or other benefits, and provider fraud occurs when a
healthcare provider submits and is compensated for false Medicaid claims.
S.B. 30 also required the commission to use learning or network technology
to identify and deter fraud in the state's Medicaid program.  S.B. 875
would set forth provisions for initiating automated tracking systems for
use in investigations of fraud in the Medicaid program. 

PURPOSE

As proposed, H.B. 875 sets forth provisions for initiating automated
tracking systems for use in investigations of fraud in the Medicaid
program. 

RULEMAKING AUTHORITY

This bill does not grant any additional rulemaking authority to a state
officer, institution, or agency. 

SECTION BY SECTION ANALYSIS

SECTION 1.  Amends Chapter 531C, Government Code, by adding Sections
531.1061 and 531.1062, as follows: 

Sec. 531.1061.  FRAUD INVESTIGATION TRACKING SYSTEM.  Requires the Health
and Human Services Commission (commission) to use an automated fraud
investigation tracking system through the commission's office of
investigations and enforcement to monitor the progress of an investigation
of suspected fraud, abuse, or insufficient quality of care under the state
Medicaid program.  Sets forth the functions of the automated fraud
investigation tracking system required for each case of suspected fraud,
abuse, or insufficient quality of care.  Requires the commission to require
each health and human services agency that performs any aspect of the state
Medicaid program to participate in the implementation and use of the
automated fraud investigation tracking system. 

Sec. 531.1062.  RECOVERY MONITORING SYSTEM.  Requires the commission to use
an automated recovery monitoring system to monitor the collections process
for a settled case of fraud, abuse, or insufficient quality of care under
the state Medicaid program.  Sets forth the functions required to be
included in the recovery monitoring system. 

SECTION 2.  Amends Section 22.0252, Human Resources Code, by adding
Subsections (c) and (d), to require the Texas Department of Human Services
(department) to ensure that the telephone collection program attempts to
collect reimbursement for all identified delinquent payments for which 15
days or more have elapsed since the initial notice of delinquency was sent
to the recipient.  Requires the department to use an automated collections
system to monitor the results of the telephone collection program.  Sets
forth the functions required to be included in the automated collections
system. 

SECTION 3.  Requires the commission, not later than January 1, 2000, to
implement the automated fraud investigation tracking system required by
Section 531.1061, Government Code, as added by this Act; and award the
contract for the purchase and installation of commercially available
accounting software necessary to implement the recovery monitoring system
required by Section 531.1062,  Government Code, as added by this Act, and
begin using the software. 

SECTION 4.  Requires the Department of Human Services, not later than
January 1, 2000, to award the contract for installation of commercially
available collections software necessary to implement the automated
collections system required by Section 22.0252, Human Resources Code, as
amended by this Act, and begin using the software. 

SECTION 5.Effective date: September 1, 1999.

SECTION 6.Emergency clause.