MINUTES
SENATE INTERIM COMMITTEE ON HEALTH & HUMAN SERVICES
Thursday, Aug. 13, 1998
9 a.m.
Senate Chamber
*****
Pursuant to a notice posted in accordance with Senate Rule
11.11, a public hearing of the Senate Interim Committee on
Health & Human Services was held on Thursday, Aug. 13, 1998,
in the Senate Chamber at Austin, Texas.
*****
MEMBERS PRESENT: MEMBERS ABSENT:
Senator Judith Zaffirini Senator John Carona
Senator Jon Lindsay Senator Chris Harris
Senator Frank Madla
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The chair called the meeting to order at 9 a.m. There being a
quorum present, the following business was transacted.
The chair laid out the May, 29, 1998, minutes and called for
revisions. There being none, Senator Madla moved approval.
There being no objection, the motion prevailed by unanimous
consent.
The chair made opening remarks and announced that the purpose
of the hearing was to adopt recommendations submitted to the
interim committee regarding Senate Bill 30 and efforts to
reduce Medicaid and welfare fraud; federal welfare reform;
Senate Bill 55, relating to restricting minors' access to
tobacco products; demographics; and patient billing. The
chair distributed copies of written motions relating to each
interim charge that would be the basis for the committee's
interim report recommendations. The interim charges, their
related motions and committee actions follow:
Interim charge of Aug. 18, 1997: The Senate Interim Committee
on Health and Human Services shall:
Monitor the implementation of SB 30, passed by the Legislature
during the 1997 regular session, regarding fraud and improper
payments under state Medicaid and welfare programs. If
needed, make recommendations for further legislative and
regulatory action.
Written Motion 1
I move that the Committee direct the committee staff to work
with the Legislative Council to draft into proposed
legislation statutory authority for the Texas Health and Human
Services Commission to
determine if civil monetary penalties should be imposed on a
provider without an automatic three-year exclusion of the
provider from the Medicaid program.
Written Motion 2
I move that the Committee direct the committee staff to work
with the Legislative Council to draft into proposed
legislation a statutory change to make state language
consistent with federal language by changing the standard of
proof for Medicaid fraud from actual knowledge to constructive
knowledge.
Written Motion 3
I move that the Committee direct the committee staff to work
with the Legislative Council to draft into proposed
legislation statutory authority for the Texas Health and Human
Services Commission to impose damages and penalties against
entities and/or .individuals that offer enticements that could
influence the decision to order or receive an item or service
from the individual or provider offering the enticement. The
language should be structured so as not to impede legitimate
recruitment.
Written Motion 4
I move that the Committee direct the Texas Health and Human
Services Commission to seek approval from the appropriate
federal authorities that would allow the Commission to hold
provider payments for an additional period not to exceed five
working days to perform fraud detection reviews.
The chair called the invited witness to provide committee
members with testimony regarding recommendations submitted to
the interim committee relating to SB 30.
The following person provided oral and written testimony:
Don Gilbert, commissioner, Texas Health and Human
Services Commission, 4900 North Lamar, Austin, Texas
78751.
The following person registered as a resource witness, but did
not testify:
Aurora LeBrun, associate commissioner, Office of
Investigations and Enforcement, Texas Health and Human
Services Commission, 4900 North Lamar, Austin, Texas
78751.
The chair laid out recommendations for written motions 2 and 3
regarding SB 30. Senator Madla moved the adoption of written
motions 2 and 3. There being no objection, the motion
prevailed by unanimous consent.
Interim charge of Aug. 18, 1997: The Senate Interim Committee
on Health and Human Services shall:
Develop a plan for oversight of efforts by state health and
human services agencies, the Attorney General, and law
enforcement agencies, to detect and reduce fraud and improper
payments under state Medicaid and welfare programs. The plan
should address enforcement and punishment under state and
federal civil and criminal laws.
Written Motion 1
I move that the Committee direct the committee staff to work
with the Legislative Council to draft proposed legislation
authorizing the Office of the Inspector General of the Texas
Department of Human Services to subpoena information regarding
suspected welfare fraud from sources such as financial
institutions, employers, schools and landlords.
Written Motion 2
I move that the Committee direct the committee staff to work
with the Legislative Council to draft a resolution directing
the Texas Department of Health to work with the Texas Health
and Human Services Commission to develop a Medicaid managed
care medical encounter reporting system.
The chair called invited panelists to provide committee
members with testimony regarding recommendations submitted to
the interim committee relating to efforts to reduce fraud and
improper payments under the state Medicaid and welfare
programs.
The following persons provided oral testimony:
Eric Bost, commissioner, Texas Department of Human
Services, P.O. Box 149030, Austin, Texas 78714-3011.
Dr. William Archer, commissioner, Texas Department of
Health, 1100 West 49th Street, Austin, Texas 78757.
The chair laid out the recommendation for written motion 2.
Senator Lindsay moved adoption of written motion 2. There
being no objection, the motion prevailed by unanimous consent.
Interim charge of Aug. 18, 1997: The Senate Interim Committee
on Health and Human Services shall:
Continue to monitor federal welfare reform, and make
recommendations for necessary legislative or regulatory
action.
Written Motion 1
I move that the Committee direct the committee staff to work
with the Legislative Council to draft into proposed
legislation a statutory change that would modify the earned
income disregard policies for families receiving Temporary
Assistance for Needy Families (TANF) benefits.
Written Motion 2
I move that the Committee direct the committee staff to work
with the Legislative Council to draft proposed legislation a
statutory change modifying state policies to allow progressive
penalties against individuals receiving Temporary Assistance
for Needy Families (TANF) benefits who do not comply with work
requirements.
Written Motion 3
I move that the Committee direct the committee staff to work
with the Legislative Council to draft into proposed
legislation a statutory change modifying state policies to
allow progressive penalties against individuals receiving
Temporary Assistance for Needy Families (TANF) benefits who do
not comply with child support requirements.
Written Motion 4
I move that the Committee direct the committee staff to
contimue to research and study the possibility of phasing out
the exemption for work based on the age of a client's youngest
child among individuals receiving Temporary Assistance for
Needy Families (TANF) benefits.
Written Motion 5
I move that the Committee direct the committee staff to work
with the Legislative Council to draft proposed legislation
creating a Legislative Oversight Committee on Welfare Reform.
The chair called invited panelists to provide committee
members with testimony regarding recommendations submitted to
the interim committee relating to federal welfare reform.
The following persons provided oral testimony:
Eric Bost, commissioner, Texas Department of Human
Services, P.O. Box 149030, Austin, Texas 78714-3011.
Monica Cruz, legislative aide, Senate Interim Committee
on Health and Human Services, P.O. Box 12068, Austin,
Texas 78711.
The following person registered as a resource witness, but did
not testify:
Larry Temple, director, Welfare Reform, Texas Workforce
Commission, 1501 East 15th Street, Austin, Texas 78701.
The chair laid out recommendations for written motions 1-5.
Senator Madla moved adoption of written motions 1-5. There
being no objection, the motion prevailed by unanimous consent.
Interim charge of Aug. 18, 1997: The Senate Interim Committee
on Health and Human Services shall:
Study the implementation of SB 55, passed by the Legislature
during the 1997 regular session, regarding minors' access to
tobacco.
Written Motion 1
I move that the Committee direct the committee staff to work
with the Legislative Council to draft into proposed
legislation a statutory change that will allow direct
appropriation of the outdoor advertising fee to the Texas
Department of Health, to be used for tobacco education and
enforcement education.
Written Motion 2
I move that the Committee direct the committee staff to work
with the Legislative Council to draft into proposed
legislation a statutory change regarding age verification in
Section 161.083 of the Health and Safety Code, to conform to
the language in federal law, which states that identification
is not required for anyone over age 26 attempting to buy
tobacco products.
Written Motion 3
I move that the Committee direct the committee staff to work
with the Legislative Council to draft into proposed language a
statutory change to Section 154.1142(b) of the Tax Code, to
add that "opportunity
for a" be inserted between "and" and "hearing" so that the
section reads, "If the comptroller finds, after notice and
opportunity for a hearing as provided by this subchapter..."
Written Motion 4
I move that the Committee direct the committee staff to work
with the Legislative Council to draft into proposed
legislation a statutory change to:
1. Section 161.088(a) of the Health and Safety Code,
replacing "county sheriffs and municipal chiefs of
police" with "local law enforcement agencies"; and
2. Section 161.088(b) of the Health and Safety Code,
replacing "sheriffs and chiefs of police" with
"local law enforcement personnel."
Written Motion 5
I move that the Committee direct committee staff to work with
the Legislative Council to draft proposed legislation to amend
Section 161.085 of the Health and Safety Code which requires
retailers to provide law enforcement officials "upon request"
or "within 72 hours" signed employee acknowledgement forms
indicating new employees have been provided written
notification of the law and agree to comply
with the law regarding the sale of tobacco products. Amend
Section 161.085 by removing the "within 72 hours" language so
forms must be provided "upon request."
Written Motion 6
I move that the Committee direct the committee staff to work
with the Legislative Council to draft proposed legislation
amending Section 161.085(e) of the Health and Safety Code so
it is consistent with Section 161.085(d) to include "peace
officers" as enforcement agents of the State Comptroller's
Office.
Written Motion 7
I move that the Committee direct the committee staff to work
with the Legislative Council, the Senate Research Center,
retailers and other stakeholders to develop for possible
future legislation language that defines "direct access" in
Section 161.086 of the Health and Safety Code as it relates to
areas to which minors have access.
Written Motion 8
I move that the Committee direct the committee staff to work
with the Legislative
Council to draft proposed legislation amending Section 154.510
of the Tax Code to exclude Section 154.504 from violations
requiring a Class A misdemeanor penalty.
Written Motion 9
I move that the Committee direct the committee staff to work
with the Legislative Council to draft proposed legislation
amending Section 161.088(d) of the Health and Safety Code to
add law enforcement to the list of authorized entities that
may use minors as decoys in sting operations. (At the request
of committee members, language will be added to Written Motion
9 to prohibit intimidation tactics toward retail clerks by
entities using minors as decoys in sting operations.)
The chair called invited panelists to provide committee
members with testimony regarding recommendations submitted to
the interim committee relating to SB 55.
The following persons provided oral testimony:
Dr. William Archer, commissioner, Texas Department of
Health, 1100 West 49th Street, Austin, Texas 78757.
Robin Herskowitz, senior policy analyst, Comptroller of
Public Accounts, 111 East 17th Street, Austin, Texas
78711-3528.
Chris Hudson, legislative aide, Senate Interim Committee
on Health and Human Services, P.O. Box 12068, Austin,
Texas 78711.
The chair laid out recommendations for written motions 1-6, 8
and 9. Senator Lindsay moved adoption of written motions 1-6,
8 and 9. There being no objection, the motion prevailed by
unanimous consent.
Senator Zaffirini moved that committee staff add language to
motion 9 to prohibit intimidation tactics toward retail clerks
by entities using minors as decoys in sting operations.
Senator Madla moved adoption. There being no objection, the
motion prevailed by unanimous consent.
Interim charge of Aug. 18, 1997: The Senate Interim Committee
on Health and Human Services shall:
Monitor developments in federal tobacco settlement discussions
and identify potential fiscal impacts to Texas governments.
The chair reported that because this is a federal issue, there
are no recommendations or motions relating to this charge.
Interim charge of Aug.18, 1997: The Senate Interim Committee
on Health and Human Services shall:
Examine the demographic trends of the state that will impact
health and human services delivery system in the future,
including immigration, rural concerns, and the aging state
population. Make recommendations for further legislative and
regulatory action.
Written Motion 1
Direct the committee staff to work with the Legislative
Council to draft proposed legislation amending Article 4512o,
Section 10, of Vernon's Annotated Civil Statutes, Licensed
Dependency Counselors, to omit the requirements that a person
applying for a chemical dependency counselor's license submit
a case presentation to the test administrator and pass an oral
examination; and amend Article 4512o, Section 11, Vernon's
Annotated Civil Statutes, Licensed Dependency Counselors, to
omit language requiring the Texas Commission on Alcohol and
Drug Abuse to contract with an organization approved by the
National Certification Reciprocity Consortium/Alcoholism and
Other Drug Abuse (NCRC/AODA) for the preparation and
administration of licensing examinations for chemcial
dependency counselors.
Written Motion 2
I move that the Committee direct the Texas Health and Human
Services Commission to:
1. Work with all health and human services agencies to
ensure that each
agency is tracking demographic information that will
affect the delivery of the agency's services in the
future; and
2. Provide an annual report to the Senate Committee on
Health and Human Services, the Lieutenant Governor
and the Speaker of the House
regarding these agencies' progress toward meeting
the needs of Texas' changing population.
The chair called invited panelists to provide committee
members with testimony regarding recommendations submitted to
the interim committee relating to demographic trends in
Texas.
The following persons provided oral testimony:
Terry Faye Bleier, executive director, Texas Commission
on Alcohol and Drug Abuse, 9001 N. IH 35, Suite 105,
Austin, Texas 78753.
Monica Cruz, legislative aide, Senate Interim Committee
on Health and Human Services, P.O. Box 12068, Austin,
Texas 78711.
The chair laid out recommendations for motions 1 and 2.
Senator Madla moved adoption of motions 1 and 2. There being
no objection, the motion prevailed by unanimous consent.
Supplemental interim charge of September 18, 1997: The Senate
Interim Committee on Health and Human Services shall:
Study current practices in patient billing by Texas hospitals
and providers of health care to evaluate the accuracy, clarity
and timeliness of patient billings. The committee should
examine existing regulatory authority and determine whether
there is sufficient authority to address problems in patient
billings. If necessary, the Committee may make
recommendations for standardizing patient billing; ensuring
that bills are accurate and complete yet simple enough for
patients to understand; providing a meaningful appeals process
for incorrect or excessive billings; and establishing
guidelines for submission of bills for payment within a
reasonable time period.
Written Motion 1
I move that the Committee direct the committee staff to work
with the Legislative Council to draft proposed legislation
adding language to the Health and Safety Code and the Texas
Medical Practice Act to explicitly prohibit balance billing
(the practice of a provider billing a patient for all charges
not paid for by the insurance plan) by health care providers
for covered benefits.
Written Motion 2
I move that the Committee direct the Texas Department of
Insurance to encourage greater vigilance by Health Maintenance
Organizations (HMOs) to ensure that their network physicians
and hospitals comply with existing state and federal laws and
their contractual obligations that prohibit balance billing.
Written Motion 3
I move that the Committee direct the committee staff to work
with the Legislative Council to draft proposed legislation to
increase the penalties for dual fee pricing in Article 21.79F
of the Texas Insurance Code from a third degree misdemeanor to
a third degree felony.
Written Motion 4
I move that the Committee:
1. Direct the committee staff to work with the
Legislative Council to draft proposed legislation to
amend Section 311.002 of the Health and Safety Code,
regarding itemized statements of billed services, to
include
specific information that must be included on a
health consumer's bill; and
2. Direct the Texas Department of Health (TDH) to draft
guidelines regarding hospital development of a
health care consumer's pamphlet or other document
that explains how to interpret hospital billing
information, and that answers frequently-asked
questions.
Written Motion 5
I move that the Committee:
1. Direct the committee staff to work with the
Legislative Council to draft proposed legislation to
amend the Health and Safety Code, Section 161.061,
Laboratory Information Required, by making
disclosure of information mandatory, not voluntary;
and
2. Direct the committee staff to work with the
Legislative Council to draft proposed legislation
to add penalties to the Health and Safety Code,
Section 161.061, if this information is not provided
to health care consumers.
Written Motion 6
I move that the Committee direct committee staff to work with
the Legislative Council to draft proposed legislation to amend
Article 4495b, Section 3.08(4)(G), Texas Medical Practice Act,
to delete the persistent and flagrant overcharging language,
and instead make a reference to the Health and Safety Code.
Written Motion 7
I move that the Committee direct committee staff to work with
the Legislative Council to draft proposed legislation to amend
the Health Professions Council's Act and the codes by which
the individual health professions boards are governed to
delete any language regarding patient billings, and instead
make a reference to the Health and Safety Code.
Written Motion 8
I move that the Committee direct the Texas Department of
Insurance (TDI) to continue monitoring activities regarding
rules proposed by the Health Care Financing Administration
relating to standardized billing forms for physicians and
hospital bills.
The chair called invited panelists to provide committee
members with testimony regarding recommendations submitted to
the interim committee relating to patient billing.
The following persons provided oral testimony:
Ron Bordelon, public counsel, Office of Public
Insurance Counsel, 333 Guadalupe, Suite 3-120,
Austin, Texas 78701.
John Evans, hospital licensing director, Health
Facility Licensing Division, Texas Department of
Health, 1100 West 49th Street, Austin, Texas 78757.
Tony Cobos, legal counsel, Texas State Board of
Medical Examiners, 333 Guadalupe, Tower III, Suite
610, Austin, Texas 78768-2018.
The chair laid out recommendations for motions 1-8. Senator
Madla moved adoption of motions 1-8. There being no
objection, the motion prevailed by unanimous consent.
With no other business to come before the committee and upon a
motion by Senator Madla, the chair recessed the committee by
unanimous consent at 10:21 a.m., subject to the call of the
chair.
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Senator Judith Zaffirini, Chair
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Scott Caffey, Committee Clerk