Texas 2017 - 85th Regular

Texas Senate Bill SB1787 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1	1		By: Hinojosa, et al. S.B. No. 1787
	2	+	(In the Senate - Filed March 9, 2017; March 23, 2017, read
	3	+	first time and referred to Committee on Health & Human Services;
	4	+	April 10, 2017, reported adversely, with favorable Committee
	5	+	Substitute by the following vote: Yeas 8, Nays 0; April 10, 2017,
	6	+	sent to printer.)
	7	+	Click here to see the committee vote
	8	+	COMMITTEE SUBSTITUTE FOR S.B. No. 1787 By: Watson
2	9
3	10
4	11		A BILL TO BE ENTITLED
5	12		AN ACT
6	13		relating to the functions and administration of the Health and
7	14		Human Services Commission and the commission's office of inspector
8	15		general in relation to fraud, waste, and abuse in health and human
9	16		services.
10	17		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	18		SECTION 1. Section 531.102, Government Code, is amended by
12	19		amending Subsections (a-3), (a-6), (j), and (k) and adding
13	20		Subsections (a-7) and (a-8) to read as follows:
14	21		(a-3) The executive commissioner is responsible for
15	22		performing all administrative support services functions necessary
16	23		to operate the office in the same manner that the executive
17	24		commissioner is responsible for providing administrative support
18	25		services functions for the health and human services system,
19	26		including functions of the office related to the following:
20	27		(1) procurement processes;
21	28		(2) contracting policies;
22	29		(3) information technology services;
23	30		(4) subject to Subsection (a-8), legal services;
24	31		(5) budgeting; and
25	32		(6) personnel and employment policies.
26	33		(a-6) The office shall conduct audits, inspections, and
27	34		investigations independent of the executive commissioner and the
28	35		commission but shall rely on the coordination required by
29	36		Subsection (a-5) to ensure that the office has a thorough
30	37		understanding of the health and human services system for purposes
31	38		of knowledgeably and effectively performing the office's duties
32	39		under this section and any other law.
33	40		(a-7) The chief counsel for the commission is the final
34	41		authority for all legal interpretations related to statutes, rules,
35	42		and commission policy on programs administered by the commission.
36	43		(a-8) For purposes of Subsection (a-3), "legal services"
37	44		includes only legal services related to open records, procurement,
38	45		contracting, human resources, privacy, litigation support by the
39	46		attorney general, bankruptcy, and other legal services as detailed
40	47		in the memorandum of understanding or other written agreement
41	48		required under Section 531.00553, as added by Chapter 837 (S.B.
42	49		200), Acts of the 84th Legislature, Regular Session, 2015.
43	50		(j) The office shall prepare a final report on each audit,
44	51		inspection, or investigation conducted under this section. The
45	52		final report must include:
46	53		(1) a summary of the activities performed by the
47	54		office in conducting the audit, inspection, or investigation;
48	55		(2) a statement regarding whether the audit,
49	56		inspection, or investigation resulted in a finding of any
50	57		wrongdoing; and
51	58		(3) a description of any findings of wrongdoing.
52	59		(k) A final report on an audit, inspection, or investigation
53	60		is subject to required disclosure under Chapter 552. All
54	61		information and materials compiled during the audit, inspection, or
55	62		investigation remain confidential and not subject to required
56	63		disclosure in accordance with Section 531.1021(g). A confidential
57	64		draft report on an audit, inspection, or investigation that
58	65		concerns the death of a child may be shared with the Department of
59	66		Family and Protective Services. A draft report that is shared with
60	67		the Department of Family and Protective Services remains
61	68		confidential and is not subject to disclosure under Chapter 552.
62	69		SECTION 2. Section 531.1021(g), Government Code, is amended
63	70		to read as follows:
64	71		(g) All information and materials subpoenaed or compiled by
65	72		the office in connection with an audit, inspection, or
66	73		investigation or by the office of the attorney general in
67	74		connection with a Medicaid fraud investigation are confidential and
68	75		not subject to disclosure under Chapter 552, and not subject to
69	76		disclosure, discovery, subpoena, or other means of legal compulsion
70	77		for their release to anyone other than the office or the attorney
71	78		general or their employees or agents involved in the audit,
72	79		inspection, or investigation conducted by the office or the
73	80		attorney general, except that this information may be disclosed to
74	81		the state auditor's office, law enforcement agencies, and other
75	82		entities as permitted by other law.
76	83		SECTION 3. The heading to Section 531.106, Government Code,
77	84		is amended to read as follows:
78	85		Sec. 531.106. LEARNING, [OR] NEURAL NETWORK, OR OTHER
79	86		TECHNOLOGY.
80	87		SECTION 4. Sections 531.106(a), (c), and (g), Government
81	88		Code, are amended to read as follows:
82	89		(a) The commission shall use learning, [or] neural network,
83	90		or other technology to identify and deter fraud in Medicaid
84	91		throughout this state.
85	92		(c) The data used for data [neural network] processing shall
86	93		be maintained as an independent subset for security purposes.
87	94		(g) Each month, the [learning or neural network] technology
88	95		implemented under this section must match vital statistics unit
89	96		death records with Medicaid claims filed by a provider. If the
90	97		commission determines that a provider has filed a claim for
91	98		services provided to a person after the person's date of death, as
92	99		determined by the vital statistics unit death records, the
93	100		commission shall refer the case for investigation to the
94	101		commission's office of inspector general.
95	102		SECTION 5. Section 531.1061(b), Government Code, is amended
96	103		to read as follows:
97	104		(b) For each case of suspected fraud, abuse, or insufficient
98	105		quality of care identified by the [learning or neural network]
99	106		technology required under Section 531.106, the automated fraud
100	107		investigation tracking system must:
101	108		(1) receive electronically transferred records
102	109		relating to the identified case from the [learning or neural
103	110		network] technology;
104	111		(2) record the details and monitor the status of an
105	112		investigation of the identified case, including maintaining a
106	113		record of the beginning and completion dates for each phase of the
107	114		case investigation;
108	115		(3) generate documents and reports related to the
109	116		status of the case investigation; and
110	117		(4) generate standard letters to a provider regarding
111	118		the status or outcome of an investigation.
112	119		SECTION 6. Section 531.1131, Government Code, is amended by
113	120		amending Subsections (a), (b), and (c) and adding Subsections
114	121		(c-1), (c-2), and (c-3) to read as follows:
115	122		(a) If a managed care organization [organization's special
116	123		investigative unit under Section 531.113(a)(1)] or an [the] entity
117	124		with which the managed care organization contracts under Section
118	125		531.113(a)(2) discovers fraud or abuse in Medicaid or the child
119	126		health plan program, the organization [unit] or entity shall:
120	127		(1) immediately submit written notice to [and
121	128		contemporaneously notify] the commission's office of inspector
122	129		general and the office of the attorney general in the form and
123	130		manner prescribed by the office of inspector general and containing
124	131		a detailed description of the fraud or abuse and each payment made
125	132		to a provider as a result of the fraud or abuse;
126	133		(2) subject to Subsection (b), begin payment recovery
127	134		efforts; and
128	135		(3) ensure that any payment recovery efforts in which
129	136		the organization engages are in accordance with applicable rules
130	137		adopted by the executive commissioner.
131	138		(b) If the amount sought to be recovered under Subsection
132	139		(a)(2) exceeds $100,000, the managed care organization
133	140		[organization's special investigative unit] or the contracted
134	141		entity described by Subsection (a) may not engage in payment
135	142		recovery efforts if, not later than the 10th business day after the
136	143		date the organization [unit] or entity notified the commission's
137	144		office of inspector general and the office of the attorney general
138	145		under Subsection (a)(1), the organization [unit] or entity receives
139	146		a notice from either office indicating that the organization [unit]
140	147		or entity is not authorized to proceed with recovery efforts.
141	148		(c) A managed care organization may retain one-half of any
142	149		money recovered under Subsection (a)(2) by the organization
143	150		[organization's special investigative unit] or the contracted
144	151		entity described by Subsection (a). The managed care organization
145	152		shall remit the remaining amount of money recovered under
146	153		Subsection (a)(2) to the commission's office of inspector general
147	154		for deposit to the credit of the general revenue fund.
148	155		(c-1) If the commission's office of inspector general
149	156		notifies a managed care organization under Subsection (b), proceeds
150	157		with recovery efforts, and recovers all or part of the payments the
151	158		organization identified as required by Subsection (a)(1), the
152	159		organization is entitled to one-half of the amount recovered for
153	160		each payment the organization identified after any applicable
154	161		federal share is deducted. The organization may not receive more
155	162		than one-half of the total amount of money recovered after any
156	163		applicable federal share is deducted.
157	164		(c-2) Notwithstanding any provision of this section, if the
158	165		commission's office of inspector general discovers fraud, waste, or
159	166		abuse in Medicaid or the child health plan program in the
160	167		performance of its duties, the office may recover payments made to a
161	168		provider as a result of the fraud, waste, or abuse as otherwise
162	169		provided by this subchapter. All payments recovered by the office
163	170		under this subsection shall be deposited to the credit of the
164	171		general revenue fund.
165	172		(c-3) The commission's office of inspector general shall
166	173		coordinate with appropriate managed care organizations to ensure
167	174		that the office and an organization or an entity with which an
168	175		organization contracts under Section 531.113(a)(2) do not both
169	176		begin payment recovery efforts under this section for the same case
170	177		of fraud, waste, or abuse.
171	178		SECTION 7. Section 531.1131, Government Code, as amended by
172	179		this Act, applies only to an amount of money recovered on or after
173	180		the effective date of this Act. An amount of money recovered before
174	181		the effective date of this Act is governed by the law in effect
175	182		immediately before that date, and that law is continued in effect
176	183		for that purpose.
177	184		SECTION 8. If before implementing any provision of this Act
178	185		a state agency determines that a waiver or authorization from a
179	186		federal agency is necessary for implementation of that provision,
180	187		the agency affected by the provision shall request the waiver or
181	188		authorization and may delay implementing that provision until the
182	189		waiver or authorization is granted.
183	190		SECTION 9. This Act takes effect immediately if it receives
184	191		a vote of two-thirds of all the members elected to each house, as
185	192		provided by Section 39, Article III, Texas Constitution. If this
186	193		Act does not receive the vote necessary for immediate effect, this
187	194		Act takes effect September 1, 2017.
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