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78R12530 KKA-F
By: Delisi H.B. No. 3204
Substitute the following for H.B. No. 3204:
By: Miller C.S.H.B. No. 3204
A BILL TO BE ENTITLED
AN ACT
relating to a front-end Medicaid fraud reduction pilot program.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter B, Chapter 32, Human Resources Code,
is amended by adding Section 32.060 to read as follows:
Sec. 32.060. FRONT-END MEDICAL ASSISTANCE FRAUD PILOT
PROGRAM. (a) In this section:
(1) "Biometric reader" means a device that confirms
the identity of a smart card bearer by reading the biometric
identification within the card.
(2) "Smart card" means a card issued to a recipient of
medical assistance that includes biometric identification of the
recipient based on the recipient's fingerprints or other physical
characteristics.
(b) The Health and Human Services Commission, with
cooperation from the Texas Department of Human Services, shall
develop and implement a front-end medical assistance fraud
reduction pilot program in the service areas containing Harris and
Dallas counties.
(c) The program must be designed to reduce:
(1) the number of medical assistance fraud cases
arising from medical and professional services billed to the
medical assistance program but not actually furnished; and
(2) the number of medical assistance fraud cases
arising from authentication fraud and abuse.
(d) The program must include use of a computer-managed
system that captures a fingerprint image or other biometric
identifying characteristic of a recipient of medical assistance and
compares that image or characteristic with other records to verify
the identity of the recipient and the presence of the recipient at
the location at which services are furnished.
(e) The system required by Subsection (d) must include:
(1) smart cards issued to recipients of medical
assistance at no cost to those recipients;
(2) secure mathematical algorithm fingerprint-imaging
that complies with applicable state and federal law; and
(3) biometric readers that are based at the locations
at which medical assistance providers furnish services and
associated local and system-wide software that is Health Level 7
(HL7) compliant.
(f) A smart card required by Subsection (e)(1) may include
color photographs of the card bearer.
(g) The commission may contract with public and private
entities to implement and operate the program.
(h) The commission may adopt rules necessary to implement
and operate the program.
(i) The commission shall seek enhanced federal matching
funds, to the extent they are available, to implement the program.
The commission may adjust the program by rule, if necessary, for the
state to become eligible for those funds.
(j) To the extent practicable, the commission shall develop
and implement the program so that smart cards and other program
components are compatible with future use of the cards and program
components to provide for direct electronic provider payments under
the medical assistance program.
SECTION 2. Not later than January 1, 2005, the Health and
Human Services Commission shall report to the governor, the
lieutenant governor, and the speaker of the house of
representatives regarding the pilot program required by Section
32.060, Human Resources Code, as added by this Act. The report must
include:
(1) an evaluation of the effectiveness of the program
in reducing Medicaid fraud; and
(2) based on that evaluation, recommendations
regarding termination, continuation, or expansion of the program.
SECTION 3. This Act takes effect immediately if it receives
a vote of two-thirds of all the members elected to each house, as
provided by Section 39, Article III, Texas Constitution. If this
Act does not receive the vote necessary for immediate effect, this
Act takes effect September 1, 2003.