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A BILL TO BE ENTITLED
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AN ACT
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relating to a review of Medicaid dental services provided to |
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children. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. (a) In this section: |
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(1) "Abuse" and "fraud" have the meanings assigned by |
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Section 531.1011, Government Code. |
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(2) "Commission" means the Health and Human Services |
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Commission. |
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(3) "Office of inspector general" means the |
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commission's office of inspector general. |
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(b) The office of inspector general shall conduct a thorough |
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review of the provision of Texas Health Steps therapeutic dental |
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benefits to children to determine whether fraud, waste, or abuse is |
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probably occurring with respect to the provision of those benefits. |
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The office shall conduct the review in conjunction with other |
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appropriate divisions of the commission and collaborate with and |
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seek input from stakeholders in the dental industry in this state. |
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(c) In determining whether fraud, waste, or abuse is |
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probably occurring in the provision of Texas Health Steps |
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therapeutic dental benefits to children, the office of inspector |
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general and the commission shall: |
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(1) review a randomly selected representative sample |
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of those services in a quantity sufficient to allow for the |
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extrapolation of results; and |
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(2) use the American Academy of Pediatric Dentistry |
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clinical guidelines and appropriate pediatric dentist peer review |
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to: |
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(A) determine dental necessity for provided |
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services; and |
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(B) assess other factors relevant to determining |
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whether fraud, waste, or abuse is probably occurring. |
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(d) Not later than November 1, 2020, the office of inspector |
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general and the commission shall submit a joint report on the |
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results of the review to the standing committees of the senate and |
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house of representatives having primary jurisdiction over |
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Medicaid. The report must include: |
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(1) a description of any policy changes implemented |
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through commission rules as a result of the review; and |
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(2) recommendations for statutory changes, including |
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any proposed legislation, to address any fraud, waste, and abuse |
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identified as probably occurring in the provision of Texas Health |
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Steps therapeutic dental benefits to children. |
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SECTION 2. This Act takes effect September 1, 2019. |