HBA-GUM S.B. 1588 76(R)    BILL ANALYSIS


Office of House Bill AnalysisS.B. 1588
By: Zaffirini
Public Health
4/27/1999
Engrossed



BACKGROUND AND PURPOSE 

Texas expended $7.3 billion in 1997 on its Medicaid program. The 75th Texas
Legislature directed the comptroller of public accounts to study the size
and nature of fraud and overpayments in the Medicaid program and other
state health care programs. S.B. 1588 requires a managed care organization
(MCO) to cooperate with Heath and Human Services Commission (HHSC)
investigations.  This bill also requires an MCO to submit certain
information to HHSC, and requires an MCO to cooperate with HHSC
investigations. 

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.  Amends Chapter 533A, Government Code, by adding Section
533.012, as follows:  

Sec. 533.012. INFORMATION FOR FRAUD CONTROL. Requires each managed care
organization (MCO) contracting with the Health and Human Services
Commission (HHSC) to submit certain specified documents to HHSC.  Requires
submitted information to be in a form prescribed by  HHSC, and be updated
as required by HHSC.  Requires the HHSC office of investigations and
enforcement to review submitted information for fraud in the Medicaid
managed care program, as appropriate.  Authorizes the comptroller of public
accounts to review the information.  

SECTION 2.  Amends Section 533.005, Government Code, to require a contract
between an MCO and HHSC to contain a requirement that the MCO provide
required information, and comply with HHSC investigations and enforcement.  

SECTION 3.  Effective date: September 1, 1999.

SECTION 4.  Makes application of this Act prospective.

SECTION 5. Emergency clause.