SRC-AXB S.B. 1588 76(R)   BILL ANALYSIS


Senate Research Center   S.B. 1588
76R5071  DLF-DBy: Zaffirini
Human Services
3/30/1999
As Filed


DIGEST 

Texas expended $7.3 billion in 1997 on its Medicaid program.  The 75th
Legislature directed the comptroller of public accounts (comptroller) to
study the size and nature of fraud and overpayments in the Medicaid program
and other state health care programs. S.B. 1588 requires managed care
organizations to cooperate with Heath and Human Services Commission
investigations. 

PURPOSE

As proposed, S.B. 1588 requires managed care organizations (MCO) to submit
certain information to the Health and Human Services Commission (HHSC), and
requires MCOs to cooperate with HHSC investigations. 

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 533A, Government Code, by adding Section
533.012, as follows: 

Sec.  533.012.  INFORMATION FOR FRAUD CONTROL.  Requires each managed care
organization (MCO) to submit certain documents and specific information to
the Health and Human Services Commission (HHSC), relating to each encounter
wherein a health care service was provided to the recipient.  Requires
submitted information to be in an HHSC prescribed form.  Requires
information to be updated.  Requires the HHSC office of investigations and
enforcement to review submitted information for Medicare fraud, as
appropriate.  Authorizes the comptroller to review the information. 

SECTION 2.  Amends Section 533.005, Government Code, to require a contract
between an MCO and HHSC to contain a requirement that the MCO provide
required information, and comply with HHSC investigations and enforcement. 

SECTION 3.  Makes application of this Act prospective.

SECTION 4.  Emergency clause.
  Effective date:  upon passage.