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.