HBA-CCH H.B. 2178 77(R) BILL ANALYSIS Office of House Bill AnalysisH.B. 2178 By: Salinas Public Health 3/23/2001 Introduced 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 3779 children who are 10 through 13 years of age have 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 that 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 that the records be corrected for any child who has been mistakenly or fraudulently diagnosed or treated for chemical dependency. RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis that rulemaking authority is expressly delegated to the Texas Commission on Alcohol and Drug Abuse and the Health and Human Services Commission in SECTION 1 (Section 531.112, Government Code) of this bill. ANALYSIS House Bill 2178 amends the Government Code to set forth that if the Health and Human Services Commission (HHSC) or any other agency that operates a portion of the state Medicaid program makes a determination that a diagnosis of chemical dependency in a child is incorrect or fraudulent, or that a funded treatment facility has provided inappropriate, improper, or unauthorized chemical dependency treatment services to a child, HHSC or the agency is required to ensure that the determination is entered in an appropriate official record of HHSC or agency, applicable medical records in HHSC's or the agency's custody, and applicable records of a company that HHSC contracts with for the processing and payment of claims under the state Medicaid program. H.B. 2178 provides that a medical or official record released by HHSC, the agency, or company that concerns the child must include HHSC's or the agency's determination. The bill requires the Texas Commission on Alcohol and Drug Abuse (TCADA) to require a funded treatment facility to correct the medical records of the misdiagnosed or inappropriately treated child. The bill requires TCADA and HHSC to adopt rules to implement these provisions. EFFECTIVE DATE September 1, 2001.