BILL ANALYSIS

C.S.H.B. 4643

By: Dorazio

Human Services

Committee Report (Substituted)

BACKGROUND AND PURPOSE

The Health and Human Services Commission's Office of Inspector General (OIG) conducts certain screening activities required at the federal and state levels for providers seeking to enroll in Medicaid, CHIP, and other state health programs. The bill author has informed the committee that the screenings and reviews promote compliance with federal and state provider enrollment program integrity requirements, increase accountability for the appropriate use of taxpayer resources by helping to prevent fraud, waste, and abuse, and protect the health and safety of Texans. In 2023, new federal requirements were established regarding the FBI's criteria for the use of criminal background check information, and the 88th Texas Legislature responded through the enactment of H.B. 4123 to update and clarify criminal background check requirements in state law. However, the bill author has further informed the committee that the FBI identified further deficiencies in state law, citing overly broad categories that they would like further defined, and granted the OIG a grace period until April 1, 2026, to make the necessary statutory changes or risk losing access to critical criminal history record information, which would make the OIG unable to complete appropriate background checks on providers to protect Texas Medicaid and healthcare program clients. C.S.H.B. 4643 seeks to address this issue by adding clear definitions in statute regarding an agency's access to criminal history record information with respect to certain public benefits programs.

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. 4643 amends the Government Code to include any agency operating part of a public benefits program, including Medicaid, among the agencies entitled to obtain certain criminal history record information that relates to an applicable provider or person applying to enroll as a provider. With respect to such a provider or an applicant, the bill removes the specification that the providers or applicants about which that information may be obtained be a Medicaid provider or applicant for enrollment as a Medicaid provider and instead specifies that the providers or applicants about which that information may be obtained are providers of a public benefits program administered by the Health and Human Services Commission (HHSC) or an applicant for enrollment as a provider under such a program.

C.S.H.B. 4643 clarifies that such criminal history record information that HHSC or the office of inspector general is authorized to obtain includes information relating to the following:

·a person that:

ohas a direct or indirect ownership interest, or a combination of direct and indirect ownership interests, that equals five percent or more in the provider or person applying to enroll as a provider;

oowns an interest of five percent or more in a mortgage, deed of trust, promissory note, or other obligation secured by the provider or person applying to enroll as a provider if that interest equals at least five percent of the value of the property or other assets of the provider or person applying to enroll as a provider;

ois an officer or director of the provider or person applying to enroll as a provider if that provider or applicant is organized as a corporation; or

ois a partner in the provider or person applying to enroll as a provider if that provider or applicant is organized as a partnership; and

·a managing employee of the provider or person applying to enroll as a provider.

C.S.H.B. 4643 defines the following terms:

·"managing employee," with respect to a provider or person applying to enroll as a provider, as an individual, including a general manager, business manager, administrator, or director, who does the following:

oexercises operational or managerial control over all or part of the provider or applicant; or

odirectly or indirectly conducts the daily operations of all or part of the provider or applicant;

·"ownership interest," with respect to a provider or person applying to enroll as a provider, as having equity in the provider's or applicant's capital, stock, or profits; and

·"provider" as an individual or entity that engages in the delivery of health care services and is authorized to deliver those services in Texas, including an individual or entity that delivers health care services to Medicaid recipients.

EFFECTIVE DATE

On passage, or, if the bill does not receive the necessary vote, September 1, 2025.

COMPARISON OF INTRODUCED AND SUBSTITUTE

While C.S.H.B. 4643 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.

The substitute includes provisions absent from the introduced expanding the agencies entitled  to obtain certain criminal history record information and changes the types of providers and applicants about which such information may be obtained.

Both the introduced and the substitute define certain terms with respect to access to criminal history record information but differ in the following ways:

·the substitute omits the definition of "Medicaid agency"; and

·the substitute replaces the definition of "provider" as an individual or entity that provides Medicaid services under an agreement with the Medicaid agency or an individual or entity that engages in the delivery of health care services through the Medicaid managed care program and is authorized by the state to deliver those services, as in the introduced, with a definition of that term as an individual or entity that engages in the delivery of health care services and is authorized to deliver those services in Texas, including an individual or entity that delivers health care services to Medicaid recipients.

The substitute changes the bill's effective date to provide for its possible immediate effect, contingent on receiving the requisite constitutional vote, whereas the introduced provided only for the bill to take effect April 1, 2025, contingent on receiving the requisite constitutional vote.