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A BILL TO BE ENTITLED
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AN ACT
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relating to unlawful acts involving certain health care programs. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 36.002, Human Resources Code, is amended |
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to read as follows: |
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Sec. 36.002. UNLAWFUL ACTS. A person commits an unlawful |
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act if the person: |
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(1) knowingly makes or causes to be made a false |
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statement or misrepresentation of a material fact to permit a |
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person to receive a benefit or payment under a health care program |
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that is not authorized or that is greater than the benefit or |
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payment that is authorized; |
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(2) knowingly conceals or fails to disclose |
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information that permits a person to receive a benefit or payment |
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under a health care program that is not authorized or that is |
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greater than the benefit or payment that is authorized; |
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(3) knowingly applies for and receives a benefit or |
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payment on behalf of another person under a health care program and |
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converts any part of the benefit or payment to a use other than for |
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the benefit of the person on whose behalf it was received; |
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(4) knowingly makes, causes to be made, induces, or |
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seeks to induce the making of a false statement or |
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misrepresentation of material fact concerning: |
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(A) the conditions or operation of a facility in |
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order that the facility may qualify for certification or |
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recertification required by a health care program, including |
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certification or recertification as: |
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(i) a hospital; |
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(ii) a nursing facility or skilled nursing |
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facility; |
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(iii) a hospice; |
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(iv) an ICF-IID; |
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(v) an assisted living facility; or |
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(vi) a home health agency; or |
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(B) information required to be provided by a |
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federal or state law, rule, regulation, or provider agreement |
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pertaining to a health care program; |
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(5) except as authorized under a health care program, |
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knowingly pays, charges, solicits, accepts, or receives, in |
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addition to an amount paid under the program, a gift, money, a |
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donation, or other consideration as a condition to the provision of |
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a service or product or the continued provision of a service or |
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product if the cost of the service or product is paid for, in whole |
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or in part, under the program; |
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(6) knowingly presents or causes to be presented a |
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claim for payment under a health care program for a product provided |
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or a service rendered by a person who: |
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(A) is not licensed to provide the product or |
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render the service, if a license is required; or |
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(B) is not licensed in the manner claimed; |
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(7) knowingly makes or causes to be made a claim under |
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a health care program for: |
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(A) a service or product that has not been |
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approved or acquiesced in by a treating physician or health care |
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practitioner; |
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(B) a service or product that is substantially |
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inadequate or inappropriate when compared to generally recognized |
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standards within the particular discipline or within the health |
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care industry; or |
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(C) a product that has been adulterated, debased, |
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mislabeled, or that is otherwise inappropriate; |
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(8) makes a claim under a health care program and |
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knowingly fails to indicate: |
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(A) the type of license held by the licensed |
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health care provider who actually provided the service; or |
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(B) [and] the identification number of the |
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licensed health care provider who actually provided the service; |
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(9) conspires to commit a violation of Subdivision |
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(1), (2), (3), (4), (5), (6), (7), (8), (10), (11), (12), or (13); |
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(10) is a managed care organization that contracts |
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with the commission or other state agency to provide or arrange to |
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provide health care benefits or services to individuals eligible |
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under a health care program and knowingly: |
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(A) fails to provide to an individual a health |
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care benefit or service that the organization is required to |
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provide under the contract; |
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(B) fails to provide to the commission or |
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appropriate state agency information required to be provided by |
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law, commission or agency rule, or contractual provision; or |
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(C) engages in a fraudulent activity in |
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connection with the enrollment of an individual eligible under the |
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program in the organization's managed care plan or in connection |
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with marketing the organization's services to an individual |
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eligible under the program; |
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(11) knowingly obstructs an investigation by the |
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attorney general of an alleged unlawful act under this section; |
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(12) knowingly makes, uses, or causes the making or |
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use of a false record or statement material to an obligation to pay |
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or transmit money or property to this state under a health care |
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program, or knowingly conceals or knowingly and improperly avoids |
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or decreases an obligation to pay or transmit money or property to |
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this state under a health care program; or |
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(13) knowingly engages in conduct that constitutes a |
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violation under Section 32.039(b). |
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SECTION 2. Section 36.002, Human Resources Code, as amended |
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by this Act, applies only to an unlawful act committed on or after |
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the effective date of this Act. |
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SECTION 3. If before implementing any provision of this Act |
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a state agency determines that a waiver or authorization from a |
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federal agency is necessary for the implementation of that |
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provision, the agency affected by the provision shall request the |
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waiver or authorization and may delay implementing that provision |
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until the waiver or authorization is granted. |
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SECTION 4. This Act takes effect September 1, 2025. |