HBA-NMO H.B. 1668 76(R) BILL ANALYSIS Office of House Bill AnalysisH.B. 1668 By: Maxey Public Health 3/18/99 Introduced BACKGROUND AND PURPOSE The 75th Texas Legislature enacted legislation that requires the comptroller to conduct a study each biennium to determine the number and type of fraudulent claims for medical or health care benefits submitted under certain medical and health programs administered by state agencies. The comptroller, while conducting the first study, encountered difficulty in retrieving information necessary to accomplish the purpose of the study. H.B. 1668 includes certain managed care programs in the purview of the study, places stipulations on information provided by state agencies that administer medical and health care programs, and requires those state agencies to maintain a list of the names and phone numbers of each person receiving benefits from its respective program. 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. SECTION BY SECTION ANALYSIS SECTION 1. Redesignates Section 403.026, Government Code, as added by Chapter 1153, Acts of the 75th Legislature, Regular Session, 1997, as Section 403.028, and amends it, as follows: Sec. 403.028. HEALTH CARE FRAUD STUDY. (a) Includes the Medicaid managed care program and managed care programs providing health care benefits as a part of the group coverages offered to active and retired state employees with those programs for which the comptroller is required to conduct a study each biennium to determine the number and type of fraudulent claims or medical or health care benefits. (b) Authorizes the comptroller or, at the request of the comptroller, a state agency that administers a health care program (state agency), for the purposes of the study conducted under this section, to make telephone contact with a person identified as receiving services for which benefits are provided under the program to confirm the delivery of such services. (c) Provides that information provided to the comptroller by a state agency must be provided in the format required by the comptroller to permit examination of both patient and health care provider histories to identify unusual or suspicious claims or patterns of claims. (d) Requires each state agency, in consultation with the comptroller, to establish performance measures to be used to evaluate the agency's fraud control procedures. (e) Provides that the comptroller's report of results must indicate whether the level of fraud in each program included in the study has increased, decreased, or remained constant since the last such report of the comptroller. SECTION 2. Amends Section 531.102, Government Code, by adding Subsection (e), as follows: (e) Requires the Health and Human Services Commission to ensure that each health and human services agency that administers a part of the Medicaid program maintains and regularly updates a list of the names and telephone numbers of all Medicaid recipients. Authorizes that the list be used to confirm the delivery to each recipient of services for which benefits are received. SECTION 3. Amends Article 3.50-2, Insurance Code (The Texas Employees Uniform Group Insurance Benefits Act), by adding Section 4H, as follows: Sec. 4H. TELEPHONE NUMBER FOR PROGRAM PARTICIPANTS. Requires the Board of Trustees of the Employees Retirement System of Texas to maintain and regularly update a list of the names and telephone numbers of all participants in any of the group health coverages offered under this Act. Authorizes that the list be used to confirm the delivery of services to each participant. SECTION 4. Amends Section 501.0431, Labor Code, as follows: Sec. 501.0431. New title: DIRECTOR'S DUTIES RELATING TO FRAUD. Replaces "compilation of statistics" with "director's duties." Requires the director of the State Office of Risk Management to maintain and regularly update a list of the names and telephone numbers of all persons entitled to medical benefits under this chapter (Workers' Compensation Insurance Coverage for State Employees, Including Employees Under the Direction or Control of the Board of Regents of Texas Tech University). Authorizes that the list be used to confirm the delivery to each person of services for which medical benefits are provided. SECTION 5.Emergency clause. Effective date: upon passage.