Bill Text: TX HB3481 | 2019-2020 | 86th Legislature | Introduced
Bill Title: Relating to investigation of fraud, waste, and abuse in Medicaid managed care by the Health and Human Services Commission's office of inspector general.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2019-03-18 - Referred to Human Services [HB3481 Detail]
Download: Texas-2019-HB3481-Introduced.html
| 86R9759 LED-D | ||
| By: Davis of Harris | H.B. No. 3481 | |
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| relating to investigation of fraud, waste, and abuse in Medicaid | ||
| managed care by the Health and Human Services Commission's office | ||
| of inspector general. | ||
| BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
| SECTION 1. Section 531.102, Government Code, is amended by | ||
| adding Subsection (z) to read as follows: | ||
| (z) The office shall develop a process to allow health care | ||
| facilities, including hospitals, and other providers to report | ||
| fraud, waste, and abuse to the office. | ||
| SECTION 2. Subchapter C, Chapter 531, Government Code, is | ||
| amended by adding Section 531.1134 to read as follows: | ||
| Sec. 531.1134. INVESTIGATIONS OF FRAUD, WASTE, AND ABUSE IN | ||
| MEDICAID MANAGED CARE. (a) In this section: | ||
| (1) "Medicaid managed care organization" means a | ||
| managed care organization as defined by Section 533.001 that | ||
| contracts with the commission under Chapter 533 to provide health | ||
| care services to Medicaid recipients. | ||
| (2) "Office" means the commission's office of | ||
| inspector general. | ||
| (3) "Potentially preventable event" has the meaning | ||
| assigned by Section 536.001. | ||
| (b) The office shall investigate the source of fraud, waste, | ||
| and abuse in Medicaid managed care contracts and whether the fraud, | ||
| waste, or abuse was committed by a Medicaid recipient, a provider, a | ||
| Medicaid managed care organization by denying services, or a | ||
| hospital by contributing to a potentially preventable event. | ||
| (c) The commission shall investigate or intervene in the | ||
| office's investigation of a Medicaid managed care organization that | ||
| is identified as an outlier among other Medicaid managed care | ||
| organizations regarding rates of denial of services based on | ||
| medical necessity. | ||
| (d) The office shall conduct a fiscal analysis of abuse in | ||
| quality-based payment outcome and process measures, including | ||
| potentially preventable events caused by a Medicaid managed care | ||
| organization's routine denial of care based on medical necessity. | ||
| (e) The office shall periodically report to the commission | ||
| the outcomes of Medicaid managed care program investigations | ||
| conducted by the office. The office may combine the report required | ||
| by this subsection with a report required by Section 531.102(j). | ||
| (f) The office shall prepare and submit to the commission | ||
| and the legislature a quarterly report recommending enforcement | ||
| actions for the Medicaid managed care program. The commission and | ||
| the office shall post each report on their respective Internet | ||
| websites. The office may combine the report required by this | ||
| subsection with the report required by Section 531.102(t). | ||
| SECTION 3. This Act takes effect immediately if it receives | ||
| a vote of two-thirds of all the members elected to each house, as | ||
| provided by Section 39, Article III, Texas Constitution. If this | ||
| Act does not receive the vote necessary for immediate effect, this | ||
| Act takes effect September 1, 2019. | ||
