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Nelson files bills addressing Medicaid costs and quantity
From staff reports
Texas State Senator Jane Nelson, R-Flower Mound, filed two pieces of legislation Wednesday designed to reduce fraud and abuse in the Medicaid system and to improve the overall quality of care in Texas Medicaid, particularly long-term care.
SB 8 confronts Medicaid fraud, which is so rampant that the Office of Inspector General has identified more than $6 billion in fraud and waste between 2004 and 2011. SB 8:
Validates the Office of Inspector General's authority to detect, investigate and prevent fraud, waste and abuse across all of our health and human services programs;
Clarifies that a provider is ineligible to participate in Medicaid once a court finds the provider liable for Medicaid fraud;
Permanently excludes providers who have been excluded or debarred from another state or federal health care program for fraud or injury;
Strengthens the prohibitions against the solicitation of Medicaid clients;
Places the Medical Transportation Program into a managed care setting; and
Directs the Health and Human Services Commission to reduce inappropriate use of ambulances for non-emergency transports.
"When you defraud the system, you are stealing from the taxpayers, children, the frail, the poor, the elderly and Texans with disabilities. It is crime against our most vulnerable citizens, and we have to change our approach to stopping it," Nelson said.
SB 7 builds on previous efforts to improve outcomes in the Medicaid system with an emphasis on improving long term care services, which is one of the top cost drivers in the Medicaid program. During her remarks, Nelson noted that Texas must redesign our Medicaid system to prepare for the growing need for long term care, given that Texas has the nation's largest senior population and a growing population of Texans with disabilities. SB 7:
· Redesigns long-term care services for individuals with intellectual and developmental disabilities;
· Directs the Health and Human Services Commission to develop quality-based payment systems that will reduce preventable events and improve outcomes for patients in the Medicaid long-term care system;
· Strengthens requirements to ensure that quality-based payment initiatives apply in managed care; and
· Expands managed care throughout Medicaid, including services provided in nursing facilities.
"These are some of the most vulnerable people we serve. We need to make sure they get the best possible care -- and that we are delivering services in a way that ensures we can keep caring for them into the future," Nelson said.
"SB 7 and SB 8 are two important Medicaid bills that give Health and Human Services the tools and direction needed to improve health care for children, the disabled, elderly and frail, while combating the threat of crowd-out that Medicaid poses on the rest of the budget," Lieutenant Governor David Dewhurst said. "I have partnered with Sen. Nelson over many sessions to achieve major reforms in Medicaid in Texas. We must continue to contain Medicaid costs and eliminate waste and fraud if we want to fund other priorities of government."