HBA-CCH H.B. 1591 77(R)    BILL ANALYSIS


Office of House Bill AnalysisH.B. 1591
By: Kitchen
Public Health
2/27/2001
Introduced



BACKGROUND AND PURPOSE 

Managed care organizations (organization) are asked to submit information
to the Texas Department of Health about the encounters or services
delivered under their contracts.  Encounter data include information
regarding the patient's medical history, diagnosis, and treatment, and are
used to measure utilization, immunization rates, health care quality, and
outcomes and to assess contract performance, the value of services to
patients, and the appropriate use of state funds.  Furthermore, states use
encounter data to assess managed care fraud and abuse.  If health care
providers do not  report complete and accurate encounter data to the
organization, the state cannot effectively evaluate Medicaid managed care.
House Bill 1591 provides for reporting and certifying the validity of
encounter data.   

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. 

ANALYSIS

House Bill 1591 amends the Government Code relating to reporting and
certifying Medicaid managed care encounter data.  In determining premium
payment rates and other amounts paid to managed care organizations under a
managed care plan, the bill prohibits the Health and Human Services
Commission (HHSC) from basing or deriving the rates or amounts on or from
encounter data, or incorporating an analysis of encounter data, unless a
certifier of encounter data (certifier) certifies the encounter data using
criteria prescribed in the bill. 

H.B. 1591 requires HHSC to collaborate with managed care organizations that
contract with HHSC  and health care providers under the organizations'
provider networks to develop incentives and mechanisms to encourage
providers to report complete and accurate encounter data to managed care
organizations in a timely manner. 

The bill requires the person acting as the state Medicaid director to
appoint a certifier no later than January 1, 2002, and provides
qualifications for the certifier.  The bill prohibits a person from being
appointed as the certifier if the person participated with HHSC in
developing premium payment rates for managed care organizations under
managed care plans in Texas during the three-year period before the date
the certifier is appointed. 

The bill requires the certifier to certify the completeness, accuracy, and
reliability of encounter data for each state fiscal year.  The bill
requires HHSC to make available to the certifier all records and all
appropriate data, and requires HHSC to provide to the certifier selected
resources and to assist with obtaining, compiling, and interpreting the
records and data.  

EFFECTIVE DATE

September 1, 2001.