SRC-DBM S.B. 1589 76(R)   BILL ANALYSIS


Senate Research Center   S.B. 1589
76R5070  DLF-DBy: Zaffirini
Human Services
3/26/1999
As Filed


DIGEST 

Texas expended $7.3 billion in 1997 on its Medicaid program, $3.8 billion
of which was spent on acute care services.  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.  The comptroller and the State Auditor's Office
reported possible overpayments of approximately $162 million for Medicaid
acute services based on 1997 expenditures.  The comptroller included
recommendations in the Fraud Measurement Study for improving the state's
ability to ensure that state health care program funds are properly
expended.   

PURPOSE

As proposed, S.B. 1589 sets forth provisions for conducting a study of
fraudulent medical or health care benefit claims submitted under certain
state programs. 

RULEMAKING AUTHORITY

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

SECTION BY SECTION ANALYSIS

SECTION 1.  Redesignates Section 403.026, Government Code, as Section
403.028, which is amended to require the comptroller of public accounts
(comptroller) to conduct a study each biennium to determine the number and
type of fraudulent claims for medical or health care benefits submitted,
including the Medicaid managed care program implemented under Chapter 533,
and managed care programs which provide health care benefits as a part of
group coverages offered to active and retired state employees.  Authorizes
the comptroller, or at the request of the comptroller, a state agency that
administers a program identified by Subsection (a) to make contact with a
person identified as receiving services for which benefits are provided
under a program to confirm delivery of services to a person. Requires the
information to be provided in a certain format.  Requires each state agency
that administers a program identified by Subsection (a), in consultation
with the comptroller, to establish performance measures to be used to
evaluate the agency's fraud control procedures.  Requires a report to
indicate whether the level of fraud in each program included in the study
has increased, decreased, or remained constant since the comptroller's last
report.  Makes conforming changes. 

SECTION 2.  Amends Section 531.102, Government Code, by adding Subsection
(e), to require the Health and Human Services Commission (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 the list to
be used to confirm the delivery of services to each recipient for which
benefits are received. 

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

Sec. 4H.  TELEPHONE NUMBER FOR PROGRAM PARTICIPANTS.  Requires the trustee
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.  Makes a conforming change. 

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

Sec. 501.0431.  New heading:  DIRECTOR'S DUTIES RELATING TO FRAUD.
Requires  the director to maintain and regularly update a list of the names
and telephone numbers of all persons entitled to confirm the delivery to
each person of services for which medical benefits are provided. 

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