HBA-NMO H.B. 1668 76(R)    BILL ANALYSIS


Office of House Bill AnalysisH.B. 1668
By: Maxey
Public Health
3/18/99
Introduced


BACKGROUND AND PURPOSE 

The 75th Texas Legislature enacted legislation that requires the
comptroller to conduct a study each biennium to determine the number and
type of fraudulent claims for medical or health care benefits submitted
under certain medical and health programs administered by state agencies.
The comptroller, while conducting the first study, encountered difficulty
in retrieving information necessary to accomplish the purpose of the study.
H.B. 1668 includes certain managed care programs in the purview of the
study, places stipulations on information provided by state agencies that
administer medical and health care programs, and requires those state
agencies to maintain a list of the names and phone numbers of each person
receiving benefits from its respective program. 
     
RULEMAKING AUTHORITY

It is the opinion of the Office of House Bill Analysis that this bill does
not expressly delegate any additional rulemaking authority to a state
officer, department, agency, or institution. 

SECTION BY SECTION ANALYSIS

SECTION 1.  Redesignates Section 403.026, Government Code, as added by
Chapter 1153, Acts of the 75th Legislature, Regular Session, 1997, as
Section 403.028, and amends it, as follows: 

Sec. 403.028.  HEALTH CARE FRAUD STUDY.  (a) Includes the Medicaid managed
care program and managed care programs providing health care benefits as a
part of the group coverages offered to active and retired state employees
with those programs for which the comptroller is required to conduct a
study each biennium to determine the number and type of fraudulent claims
or medical or health care benefits. 

(b)  Authorizes the comptroller or, at the request of the comptroller, a
state agency that administers a health care program (state agency), for the
purposes of the study conducted under this section, to make telephone
contact with a person identified as receiving services for which benefits
are provided under the program to confirm the delivery of such services. 

(c) Provides that information provided to the comptroller by a state agency
must be provided in the format required by the comptroller to permit
examination of both patient and health care provider histories to identify
unusual or suspicious claims or patterns of claims. 

(d) Requires each state agency, in consultation with the comptroller, to
establish performance measures to be used to evaluate the agency's fraud
control procedures. 

(e) Provides that the comptroller's report of results must indicate whether
the level of fraud in each program included in the study has increased,
decreased, or remained constant since the last such report of the
comptroller. 

SECTION 2.  Amends Section 531.102, Government Code, by adding Subsection
(e), as follows: 

(e) Requires the Health and Human Services Commission to ensure that each
health and human services agency that administers a part of the Medicaid
program maintains and  regularly updates a list of the names and telephone
numbers of all Medicaid recipients. Authorizes that the list be used to
confirm the delivery to each recipient of services for which benefits are
received. 

SECTION 3.  Amends Article 3.50-2, Insurance Code (The Texas Employees
Uniform Group Insurance Benefits Act), by adding Section 4H, as follows: 

Sec. 4H.  TELEPHONE NUMBER FOR PROGRAM PARTICIPANTS.  Requires the Board of
Trustees of the Employees Retirement System of Texas to maintain and
regularly update a list of the names and telephone numbers of all
participants in any of the group health coverages offered under this Act.
Authorizes that the list be used to confirm the delivery of services to
each participant. 

SECTION 4.  Amends Section 501.0431, Labor Code, as follows:

Sec. 501.0431.  New title:  DIRECTOR'S DUTIES RELATING TO FRAUD.  Replaces
"compilation of statistics" with "director's duties."  Requires the
director of the State Office of Risk Management to maintain and regularly
update a list of the names and telephone numbers of all persons entitled to
medical benefits under this chapter (Workers' Compensation Insurance
Coverage for State Employees, Including Employees Under the Direction or
Control of the Board of Regents of Texas Tech University).  Authorizes that
the list be used to confirm the delivery to each person of services for
which medical benefits are provided.      

SECTION 5.Emergency clause.
  Effective date: upon passage.