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.