HBA-DMH H.B. 1228 77(R) BILL ANALYSIS Office of House Bill AnalysisH.B. 1228 By: Maxey Public Health 2/21/2001 Introduced BACKGROUND AND PURPOSE The House Committee on General Investigating conducted an interim investigation on the excessive use of stainless steel crowns and other aggressive dental procedures by certain providers in the Medicaid program. This investigation found some evidence of fraud in the Texas Health Steps Dental Services Program. Various procedures and certain billing codes offer providers the chance to defraud the dental program. The committee recommended various changes to help eliminate abuse of the system, and to improve the quality of services and care offered by the program. House Bill 1228 incorporates the recommendations of the House Committee on General Investigating to reduce fraud in the program. RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis that rulemaking authority is expressly delegated the Health and Human Services Commission in SECTION 1 (Section 32.053, Human Resources Code) of this bill. ANALYSIS House Bill 1228 amends the Human Resources Code to require the Health and Human Services Commission (HHSC), in providing dental services under the medical assistance program (Medicaid), to: _ensure that a stainless steel crown is used only when medically necessary and not as a preventive measure; _require a dentist participating in Medicaid to document, through x-rays or other methods established by HHSC rule, the medical necessity for a stainless steel crown before it is applied; _require a dentist participating in Medicaid to comply with a minimum standard of documentation and record-keeping for each of the dentists; _establish such a minimum standard in cooperation with the State Board of Dental Examiners; _replace the 15-point system used for determining the medical necessity for hospitalization and general anesthesia with a more objective and comprehensive system developed by HHSC; _take all necessary action to eliminate fraud in the provision of dental services; and _reduce the hospitalization fee and eliminate the behavior management and nutritional consultation fees and redistribute amounts made available by such actions to other commonly billed dental services for which adequate accountability measures exist. EFFECTIVE DATE On passage, or if the Act does not receive the necessary vote, the Act takes effect September 1, 2001.