HBA- NRS, CCH C.S.H.B. 2178 77(R)BILL ANALYSIS


Office of House Bill AnalysisC.S.H.B. 2178
By: Salinas
Public Health
4/18/2001
Committee Report (Substituted)


BACKGROUND AND PURPOSE 

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.  C.S.H.B. 2178
requires a diagnosis of chemical dependency be expunged from a child's
records following the final conviction of a chemical dependency treatment
provider for submitting a fraudulent claim for Medicaid reimbursement. 

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. 

ANALYSIS

C.S.H.B. 2178 amends the Government Code to require the Health and Human
Services Commission (HHSC) or other agency that operates a portion of the
state Medicaid program, following the final conviction of a chemical
dependency treatment provider for submitting a fraudulent claim for
Medicaid reimbursement to expunge a diagnosis of chemical dependency in a
child that has been entered in any appropriate official record of HHSC or
an agency, applicable medical records in HHSC's or an agency's custody, and
applicable records of a company that HHSC contracts with for the processing
and payment of Medicaid claims. 

EFFECTIVE DATE

September 1, 2001.

COMPARISON OF ORIGINAL TO SUBSTITUTE

C.S.H.B. 2178 modifies the original bill by requiring a diagnosis of
chemical dependency to be expunged from a child's records following the
final conviction of a chemical dependency treatment provider for filing a
fraudulent claim rather than requiring the Health and Human Services
Commission (HHSC) to include a determination of fraud in the child's
records.  The substitute removes provisions requiring the Texas Commission
on Alcohol and Drug Abuse (TCADA) to require a funded treatment facility to
correct fraudulent records of children.  The substitute also removes the
provision requiring TCADA and HHSC to adopt rules to implement the
determination process.