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


Senate Research CenterC.S.S.B. 1589
76R10755  DLF-DBy: Zaffirini
Human Services
3/31/1999
Committee Report (Substituted)


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, C.S.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), in consultation with the office of the state auditor, to
conduct a study each biennium to determine the number and type of
fraudulent claims for medical or health care benefits submitted under the
state Medicaid program, including the Medicaid managed care program
implemented under Chapter 533.  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 agreed to by the comptroller and the state
agency.  Requires each state agency that administers a program identified
by Subsection (a), in consultation with the comptroller and the office of
the state auditor, 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.Emergency clause.
  Effective date: upon passage.  

SUMMARY OF COMMITTEE CHANGES

SECTION 1.

Redesignates Section 403.026, Government Code, as Section 403.028, which is
amended to require the comptroller of public accounts (comptroller), in
consultation with the office of the state auditor, 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.  Requires the information to be
provided in a certain format agreed to by the comptroller and the state
agency.  Requires each state agency that administers a program identified
by Subsection (a), in consultation with the comptroller and the office of
the state auditor, to establish performance measures to be used to evaluate
the agency's  fraud control procedures.  Deletes text regarding managed
care programs which provide health care benefits as a part of group
coverages offered to active and retired state employees. 

SECTION 2.

 Deletes existing SECTIONS 2 - 4.  Redesignated from existing SECTION 5.