Texas 2019 - 86th Regular

Texas House Bill HB3481 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	86R9759 LED-D
2	2	By: Davis of Harris H.B. No. 3481
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to investigation of fraud, waste, and abuse in Medicaid
8	8	managed care by the Health and Human Services Commission's office
9	9	of inspector general.
10	10	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	11	SECTION 1. Section 531.102, Government Code, is amended by
12	12	adding Subsection (z) to read as follows:
13	13	(z) The office shall develop a process to allow health care
14	14	facilities, including hospitals, and other providers to report
15	15	fraud, waste, and abuse to the office.
16	16	SECTION 2. Subchapter C, Chapter 531, Government Code, is
17	17	amended by adding Section 531.1134 to read as follows:
18	18	Sec. 531.1134. INVESTIGATIONS OF FRAUD, WASTE, AND ABUSE IN
19	19	MEDICAID MANAGED CARE. (a) In this section:
20	20	(1) "Medicaid managed care organization" means a
21	21	managed care organization as defined by Section 533.001 that
22	22	contracts with the commission under Chapter 533 to provide health
23	23	care services to Medicaid recipients.
24	24	(2) "Office" means the commission's office of
25	25	inspector general.
26	26	(3) "Potentially preventable event" has the meaning
27	27	assigned by Section 536.001.
28	28	(b) The office shall investigate the source of fraud, waste,
29	29	and abuse in Medicaid managed care contracts and whether the fraud,
30	30	waste, or abuse was committed by a Medicaid recipient, a provider, a
31	31	Medicaid managed care organization by denying services, or a
32	32	hospital by contributing to a potentially preventable event.
33	33	(c) The commission shall investigate or intervene in the
34	34	office's investigation of a Medicaid managed care organization that
35	35	is identified as an outlier among other Medicaid managed care
36	36	organizations regarding rates of denial of services based on
37	37	medical necessity.
38	38	(d) The office shall conduct a fiscal analysis of abuse in
39	39	quality-based payment outcome and process measures, including
40	40	potentially preventable events caused by a Medicaid managed care
41	41	organization's routine denial of care based on medical necessity.
42	42	(e) The office shall periodically report to the commission
43	43	the outcomes of Medicaid managed care program investigations
44	44	conducted by the office. The office may combine the report required
45	45	by this subsection with a report required by Section 531.102(j).
46	46	(f) The office shall prepare and submit to the commission
47	47	and the legislature a quarterly report recommending enforcement
48	48	actions for the Medicaid managed care program. The commission and
49	49	the office shall post each report on their respective Internet
50	50	websites. The office may combine the report required by this
51	51	subsection with the report required by Section 531.102(t).
52	52	SECTION 3. This Act takes effect immediately if it receives
53	53	a vote of two-thirds of all the members elected to each house, as
54	54	provided by Section 39, Article III, Texas Constitution. If this
55	55	Act does not receive the vote necessary for immediate effect, this
56	56	Act takes effect September 1, 2019.