Office of House Bill AnalysisH.B. 2178
By: Salinas
Public Health


Medicaid reimbursement rates might provide unscrupulous chemical dependency
providers with an incentive to over diagnose and over treat children for
chemical dependency.  From February 1997 through January 2001, the Health
and Human Services medicaid fraud division found that 1170 children in
Texas less than 10 years of age were diagnosed as chemically dependent or
chemically abusive, and 3779 children who are 10 through 13 years of age
have received chemical dependency treatments.  It is believed that some of
these diagnoses are incorrect and fraudulent and that treatment for
chemical dependency is unwarranted for some of these children.  After
chemical dependency services are rendered and a Medicaid claim is filed
with the National Health Insurance Corporation (NHIC), the child's
treatment history is entered into the NHIC database that can then be
accessed by private insurance companies when researching potential
policyholders for pre-existing conditions.  Consequently, children can be
stigmatized and penalized throughout their lives for an incorrect or
fraudulent diagnosis of  chemical dependency or abuse.  House Bill 2178
requires that the records be corrected for any child who has been
mistakenly or fraudulently diagnosed or treated for chemical dependency. 


It is the opinion of the Office of House Bill Analysis that rulemaking
authority is expressly delegated to the Texas Commission on Alcohol and
Drug Abuse and the Health and Human Services Commission in SECTION 1
(Section 531.112, Government Code) of this bill. 


House Bill 2178 amends the Government Code to set forth that if the Health
and Human Services Commission (HHSC) or any other agency that operates a
portion of the state Medicaid program makes a determination that a
diagnosis of chemical dependency in a child is incorrect or fraudulent, or
that a funded treatment facility has provided inappropriate, improper, or
unauthorized chemical dependency treatment services to a child, HHSC or the
agency is required to ensure that the determination is entered in an
appropriate official record of HHSC or agency, applicable medical records
in HHSC's or the agency's custody, and applicable records of a company that
HHSC contracts with for the processing and payment of claims under the
state Medicaid program. H.B. 2178 provides that a medical or official
record released by HHSC,  the agency, or company that concerns the child
must include HHSC's or the agency's determination.  The bill requires the
Texas Commission on Alcohol and Drug Abuse (TCADA) to require a funded
treatment facility to correct the medical records of the misdiagnosed or
inappropriately treated child. The bill requires TCADA and HHSC to adopt
rules to implement these provisions. 


September 1, 2001.