HBA- NRS, CCH H.B. 2178 77(R)BILL ANALYSIS


Office of House Bill AnalysisH.B. 2178
By: Salinas
Public Health
7/16/2001
Enrolled


BACKGROUND AND PURPOSE 

Medicaid reimbursement rates might provide unscrupulous chemical dependency
providers with an incentive to over diagnose and over treat children for
chemical dependency.  From February 1997 through January 2001, the Health
and Human Services Medicaid fraud division found that 1170 children in
Texas less than 10 years of age were diagnosed as chemically dependent or
chemically abusive and that 3779 children ages 10 through 13 received
chemical dependency treatments.  It is believed that some of these
diagnoses are incorrect and fraudulent and that treatment for chemical
dependency is unwarranted for some of these children.  After chemical
dependency services are rendered and a Medicaid claim is filed with the
National Health Insurance Corporation (NHIC), the child's treatment history
is entered into the NHIC database, which can then be accessed by private
insurance companies when researching potential policyholders for
pre-existing conditions.  Consequently, children can be stigmatized and
penalized throughout their lives for an incorrect or fraudulent diagnosis
of  chemical dependency or abuse. House Bill 2178 requires a diagnosis of
chemical dependency to be expunged from a child's records following the
final conviction of a chemical dependency treatment provider for submitting
a fraudulent claim for Medicaid reimbursement. 

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. 

ANALYSIS

House Bill 2178 amends the Government Code to require the Health and Human
Services Commission (HHSC) or other agency that operates a portion of the
state Medicaid program, following the final conviction of a chemical
dependency treatment provider for submitting a fraudulent claim for
Medicaid reimbursement to expunge a diagnosis of chemical dependency in a
child that has been entered in any appropriate official record of HHSC or
an agency, applicable medical records in HHSC's or an agency's custody, and
applicable records of a company that HHSC contracts with for the processing
and payment of Medicaid claims. 

EFFECTIVE DATE

September 1, 2001.