HBA-GUM C.S.S.B. 1588 76(R)BILL ANALYSIS Office of House Bill AnalysisC.S.S.B. 1588 By: Zaffirini Public Health 5/7/1999 Committee Report (Substituted) 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. C.S.S.B. 1588 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 Subchapter A, Chapter 533, Government Code, by adding Section 533.012, as follows: Sec. 533.012. INFORMATION FOR FRAUD CONTROL. (a) Requires each managed care organization (MCO) contracting with the Health and Human Services Commission (HHSC) to submit certain specified documents to HHSC. (b) Provides that submitted information must be in a form prescribed by HHSC, and be updated as required by HHSC. (c) 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. (d) Provides that for a subcontractor who reenrolled as a provider in the Medicaid program as required by Section 2.07 (Development of New Provider Contract), Chapter 1153, Acts of the 75th Legislature, Regular Session, 1997, or who modified a contract in compliance with that section, a managed care organization is not required to submit, and the provider is not required to provide, fraud control information different than the information submitted in connection with the reenrollment or contract modification. (e) Provides that certain specified information submitted to HHSC under Subsection (a) is confidential and not subject to disclosure under Chapter 552 (Public Information), Government Code. 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. COMPARISON OF ORIGINAL TO SUBSTITUTE The substitute modifies the original in SECTION 1 in proposed Section 533.012 (Information for Fraud Control), Government Code, to make a nonsubstantive change, and add Subsections (d) and (e). New Subsection (d) provides that for a subcontractor who reenrolled as a provider in the Medicaid program, or who modified a contract in a specified manner, a managed care organization is not required to submit, and the provider is not required to provide, fraud control information which is not connected with the reenrollment or contract modification. New Subsection (e) provides that information describing a financial or other business relationship between an organization and a subcontractor providing health care services under a contract with the Health and Human Services Commission is confidential, and is not subject to disclosure under Chapter 552 (Public Information), Government Code.