Bill Caption

Relating to the provision and delivery of certain health and human services in this state.

Fiscal Notes

Estimated Two-year Net Impact to General Revenue Related Funds for SB8, Committee Report 2nd House, Substituted: a positive impact of $14,697,534 through the biennium ending August 31, 2015. The bill would make no appropriation but could provide the legal basis for an appropriation of funds to implement the provisions of the bill.

Bill Analysis

SB 8 would enact law meant to prevent waste, fraud and abuse within Texas’ Medicaid program. SB 8 would:

• Require the Executive Commissioner of Health and Human Services Commission (Commission) to create a Data Analysis Unit to improve contract management, detect data trends, and identify anomalies within Medicaid and other programs.
• Forbid Medicaid and child health plan program providers from engaging in marketing that involves unsolicited personal contact intended to influence a patient’s choice of provider.
• Require the commission to partner with the Texas Department of Motor Vehicles and Department of Public Safety to share information on medical transportation providers to ensure compliance.
• Require the Commission to set up medical transportation program services throughout Texas.
• Increase licensing requirements for Emergency Medical Service providers, such as requiring providers obtain a letter of approval from the commissioners court of the county they will serve in, or the municipality.
• Require Emergency Medical Service Providers to provide the Department of State Health Services with letters of credit and surety bonds to obtain or renew a license, except if they are operated by a governmental entity.
• Require governmental entities, in extending letters of approval, to consider whether licensing another emergency medical service provider will “adversely affect the provision of emergency medical services” by already licensed providers, whether there is a shortage of providers, and whether licensing another will cause an oversupply in providers.
• Prohibit providers from serving other municipalities until the second year they have been licensed, except in cases of emergency or if a provider is awarded another contract by another municipality.
• Give the Commission power to revoke, suspend, or deny licenses for certain violations, including Medicaid or Medicare fraud conviction.
• Require the commissioner to create rules that revoke a provider’s license if they have been excluded from a state or federally funded health care plan for certain criminal convictions involving fraud or injuries to elderly, disabled, or youth patients.
• Allow licenses to be reinstated with good cause and if the provider has not committed another act that would require revocation.
• Require a provider's ineligibility begin when the decision that a provider is at fault becomes final.

Analysis: SB 8 seeks to root out fraud within Texas’ Medicaid and child health care programs. According to the Legislative Budget Board, SB 8’s provisions will save taxpayers approximately $72 million over Fiscal Years 2014-2018. Generally we do not support increased regulation on private enterprise. However, this legislation deals with regulations pertaining to providers who accept reimbursement from taxpayer funded health care programs. As such, the state has a fiduciary duty to the taxpayers to ensure that their money is being spent in the way that it was intended and that it is not being spent fraudulently. If businesses wish to avoid the regulations, they are free to opt out of providing care reimbursable by federal and state programs. If the LBB’s projections hold true, SB 8 would save taxpayers millions of dollars by counteracting waste, fraud, and abuse. We support this legislation.