BILL ANALYSIS

C.S.H.B. 142

By: Noble

Human Services

Committee Report (Substituted)

BACKGROUND AND PURPOSE

According to the office of inspector general (OIG) of the Health and Human Services Commission in information provided to the House Committee on Human Services of the 89th Texas Legislature, Regular Session, the OIG faces multiple barriers under current law. For instance, the OIG notes that there are conflicting statutory provisions relating to the procurement of experts, the OIG is prohibited from conducting criminal history checks on licensed health care professionals who are in good standing, there are inefficacies regarding the required fraud hotline, and the OIG is unable to coordinate with other states in detecting fraud, waste, and abuse in Texas' health and human services programs.

C.S.H.B. 142 seeks to clarify these issues by correcting those conflicting provisions, narrowing the prohibition to fingerprint-based criminal history record information check, providing flexibility in the manner the OIG receives reports of fraud, waste, and abuse, and authorizing the OIG to disclose information to other governmental bodies. Additionally, the bill seeks to repeal a requirement for an annual review of Medicaid claims based on a method that is outdated and produces limited results.

CRIMINAL JUSTICE IMPACT

It is the committee's opinion that this bill does not expressly create a criminal offense, increase the punishment for an existing criminal offense or category of offenses, or change the eligibility of a person for community supervision, parole, or mandatory supervision.

RULEMAKING AUTHORITY

It is the committee's opinion that this bill does not expressly grant any additional rulemaking authority to a state officer, department, agency, or institution.

ANALYSIS

C.S.H.B. 142 amends the Government Code to set out and revise provisions relating to the administration, authority, and duties of the office of inspector general (OIG) of the Health and Human Services Commission (HHSC).

Contract for Review of Investigative Findings by Qualified Expert

C.S.H.B. 142 removes the following statutory provisions relating to contracts for the services of a qualified expert to review the OIG's investigative findings based on medical necessity, the quality of medical care, the necessity of dental services, or the quality of dental care:

·the authorization for HHSC, if it did not receive any responsive bids on a competitive solicitation for the services and the number of contracts to be awarded is not otherwise limited, to negotiate with and award a contract for the services on the basis of the contractor's agreement to a set fee and the contractor's affirmation and the OIG's verification that the contractor possesses the necessary occupational licenses and experience; and

·the provision establishing that a contract awarded on that basis is not subject to competitive advertising and proposal evaluation requirements.

The bill establishes instead that a qualified expert retained by HHSC on behalf of the OIG is considered an expert witness for purposes of the exemption to obtain such witnesses from the State Purchasing and General Services Act.

Permitted Disclosure of Certain Information

C.S.H.B. 142 authorizes the OIG, for purposes of performing its statutory duties, to disclose information obtained in the course of conducting the OIG's administrative oversight activities to the following persons and entities:

·a federal, state, or local governmental entity, including:

oa federal agency or an agency of this state or another state;

othe criminal, civil, or administrative department, division, bureau, or other entity with enforcement or prosecutorial authority of this state, the United States, another state, or a local governmental entity of this state or another state; and

oa political subdivision of this state; or

·a person authorized by the OIG to receive the information.

Medicaid Provider Criminal History Record Checks

C.S.H.B. 142 makes the following changes to the prohibition against the OIG conducting a criminal history record information check of a health care professional to determine the professional's eligibility to participate as a Medicaid provider if the OIG confirmed with a licensing authority that the professional is licensed and in good standing:

·specifies that the prohibition applies to a fingerprint-based criminal history record information check; and

·specifies that the prohibition does not apply if federal law requires otherwise.

Fraud Reporting Method

C.S.H.B. 142 changes from a toll-free telephone hotline to an appropriate communications system the type of communication method that HHSC or a health and human services agency must maintain and promote for reporting suspected fraud in programs HHSC or a health and human services agency administers.

Repealed Requirements

C.S.H.B. 142 repeals Section 544.0201 and Section 544.0252(a), Government Code, which respectively do the following:

·require HHSC to annually select and review a random, statistically valid sample of all claims for Medicaid reimbursement, including under the vendor drug program, for potential cases of fraud, waste, or abuse and to use the annual review results to determine the types of claims toward which HHSC resources for fraud and abuse detection should be primarily directed; and

·require the OIG to conduct a preliminary investigation of an allegation of fraud or abuse against a provider that HHSC receives from any source to determine whether there is a sufficient basis to warrant a full investigation, with specified deadlines for the beginning and completion of that preliminary investigation.

Federal Waiver Contingency

If before implementing any provision of the bill a state agency determines that a waiver or authorization from a federal agency is necessary for implementation of that provision, the agency affected by the provision must request the waiver or authorization and may delay implementing that provision until the waiver or authorization is granted.

EFFECTIVE DATE

September 1, 2025.

COMPARISON OF INTRODUCED AND SUBSTITUTE

While C.S.H.B. 142 may differ from the introduced in minor or nonsubstantive ways, the following summarizes the substantial differences between the introduced and committee substitute versions of the bill.

Whereas the introduced established that the State Purchasing and General Services Act does not apply to HHSC's procuring of a contract for the services of a qualified expert to the same extent that act does not apply to obtaining expert witnesses for legal services, the substitute establishes that a qualified expert retained by HHSC on behalf of the OIG is considered an expert witness for purposes relating to the exemption for legal services under that act.