84th Texas Lege Under Way – Bills to Look Out For

There have been a number of bills introduced in the  initial filings of the 84th Texas Legislative Session during January 2015. Of special interest to the Texas therapy services industry is:

SB219 (Schwertner, Hinojosa, Nelson), see https://legiscan.com/TX/text/SB219/2015, consists of nearly 2,300 pages, with many struck-through or corrected statements. This bill has to do with (1) enhancing benefits for mental/behaviorial health, (2) clarifying the powers of the HHSC commissioner, especially with respect to handling contracts with HHSC, (3) identifying how the HHSC-OIG is to report accountability for fraud detection and its results, (4) clarifying statutory provisions of the state healthcare rules, (5) imposition of fees, and (6) licensing of provider types (direct mention of therapists was not present). Of particular interest in this bill is how it may potentially change the way that the OIG goes about its business of reporting fraud detection and the enforcement of the state’s anti-fraud laws. Additionally, the bill interjects new or clarified procedures that the HHSC commissioner must follow, especially in the area of contract procurement. New definitions of mentally disabled patients or condition is given, as “intellectual disabilities” and of various eligibility criteria for them and with respect to state juvenile custody laws. Imposition of fees for providers applying for state programs is spelled out more clearly, as well as the licensing to be required of certain provider types, such as massage therapists. If a therapy-based organization employs massage therapists as part of their regimen of services, these individuals will have to be licensed appropriately, even if such services may not be reimbursable through Medicaid, according to the bill.

HB550 (F. Price) (House version of SB219), see https://legiscan.com/TX/text/HB550/2015.

HB956 (C. Turner), see https://legiscan.com/TX/text/HB956/2015, clarifies and makes more detailed the definitions of a claimant (patient or representative thereof) and claim in the case of a possible provider negligence lawsuit in Texas. In the particular context of a Texas therapist or therapy-based organization, a plaintiff can now be a representative acting on behalf of the patient that was allegedly harmed as claimed in a lawsuit.

SB353 (Nelson), see http://www.capitol.state.tx.us/tlodocs/84R/billtext/html/SB00353I.htm, a Senate bill, and HB649 (McClendon), see http://www.legis.state.tx.us/tlodocs/84R/billtext/pdf/HB00649I.pdf#navpanes=0; a House bill, both introduced to reign in no-bid  contracting  in  HHSC; something that led to the resignations of Stick and Wilson and the continuing investigations into Stick’s activities with his wife, Wilson’s wife and a mutual political aide  with  Janek. We have chronicled these activities earlier in this portal. Among other things, the bill would  require that a contractor reveal everything about their technologies and methodologies, including any proprietary information,  to  HHSC, and to additionally have a gatekeeper that is independent of the people in the agency that would be assessing the technology of the contractor as well as adequate ethics training for state agency personnel in the contracting bid process.

If the now infamous fraud-detection software of the contractor 21CT that Jack Stick had embraced, had had to reveal such technology, they would have had to clearly demonstrate how the algorithms work under the guise of “graph pattern analysis”, what their proprietary algorithms do, how that would have helped alleviate fraud-detection difficulties, including hastening the process and demonstrate the accuracy of such results to agency technologists and reviewers apriori. The existing patents on those algorithms are already available to the public via federal rules of patenting. One would have, upon closer scrutiny and with some mathematical expertise, surmised that those algorithms are based on others’ work from the past 10 years of industry research, a clearly free resource to the public. In other words, these algorithms could have been coded by contract programmers for the state agencies for a fraction of the $110 million dollar contract. Quantum Decision Research will be publishing to the general public, an analysis of graph pattern analytics (GPA), its current state-of-the-art in academia, and how such algorithms could be used to more quickly surmise patterns of association between business and government entities in transaction histories. One such type of history would be the claims history of a provider with Medicaid. Nonetheless, GPA is not infallible, it could easily lead to false associations, (i.e., guilt by association).

SB89 (Ellis), (see http://www.legis.state.tx.us/tlodocs/84R/billtext/pdf/SB00089I.pdf#navpanes=0) and Trey Martinez-Fisher (House version) to have HHSC follow the expanded Medicaid clause of the ACA and adapt it to HHSC’s Medicaid programs.

There will be other bills introduced pertaining to Medicaid providers and therapists in particular in the coming days. Stay tuned. All bills are being reviewed. As of now they consist of thousands of pages. They will invariably change during the course of the session.