Sec. 531.1032. OFFICE OF INSPECTOR GENERAL: CRIMINAL HISTORY RECORD INFORMATION CHECK. (a) The office and each licensing authority that requires the submission of fingerprints for the purpose of conducting a criminal history record information check of a health care professional shall enter into a memorandum of understanding to ensure that only persons who are licensed and in good standing as health care professionals participate as providers in Medicaid. The memorandum under this section may be combined with a memorandum authorized under Section 531.1031(c-1) and must include a process by which:
(1) the office may confirm with a licensing authority that a health care professional is licensed and in good standing for purposes of determining eligibility to participate in Medicaid; and
(2) the licensing authority immediately notifies the office if:
(A) a provider's license has been revoked or suspended; or
(B) the licensing authority has taken disciplinary action against a provider.
(b) The office may not, for purposes of determining a health care professional's eligibility to participate in Medicaid as a provider, conduct a criminal history record information check of a health care professional who the office has confirmed under Subsection (a) is licensed and in good standing. This subsection does not prohibit the office from performing a criminal history record information check of a provider that is required or appropriate for other reasons, including for conducting an investigation of fraud, waste, or abuse.
Text of subsection as added by Acts 2015, 84th Leg., R.S., Ch. 837, Sec. 2.15(b)
(c) For purposes of determining eligibility to participate in Medicaid and subject to Subsection (d), the office, after seeking public input from various geographic areas across this state, either in person or through teleconferencing centers, shall establish and the executive commissioner by rule shall adopt guidelines for the evaluation of criminal history record information of providers and potential providers. The guidelines must outline conduct, by provider type, that may be contained in criminal history record information that will result in exclusion of a person from Medicaid as a provider, taking into consideration:
(1) the extent to which the underlying conduct relates to the services provided under Medicaid;
(2) the degree to which the person would interact with Medicaid recipients as a provider; and
(3) any previous evidence that the person engaged in fraud, waste, or abuse under Medicaid.
Text of subsection as added by Acts 2015, 84th Leg., R.S., Ch. 945, Sec. 5
(c) For purposes of determining eligibility to participate in Medicaid and subject to Subsection (d), the office, after seeking public input, shall establish and the executive commissioner by rule shall adopt guidelines for the evaluation of criminal history record information of providers and potential providers. The guidelines must outline conduct, by provider type, that may be contained in criminal history record information that will result in exclusion of a person from Medicaid as a provider, taking into consideration:
(1) the extent to which the underlying conduct relates to the services provided under Medicaid;
(2) the degree to which the person would interact with Medicaid recipients as a provider; and
(3) any previous evidence that the person engaged in fraud, waste, or abuse under Medicaid.
(d) The guidelines adopted under Subsection (c) may not impose stricter standards for the eligibility of a person to participate in Medicaid than a licensing authority described by Subsection (a) requires for the person to engage in a health care profession without restriction in this state.
(e) The office and the commission shall use the guidelines adopted under Subsection (c) to determine whether a provider participating in Medicaid continues to be eligible to participate in Medicaid as a provider.
(f) The provider enrollment contractor, if applicable, and a managed care organization participating in Medicaid shall defer to the office regarding whether a person's criminal history record information precludes the person from participating in Medicaid as a provider.
Added by Acts 2015, 84th Leg., R.S., Ch. 837 (S.B. 200), Sec. 2.15(b), eff. September 1, 2015.
Added by Acts 2015, 84th Leg., R.S., Ch. 945 (S.B. 207), Sec. 5, eff. September 1, 2015.
Structure Texas Statutes
Subtitle I - Health and Human Services
Chapter 531 - Health and Human Services Commission
Subchapter C. Medicaid and Other Health and Human Services Fraud, Abuse, or Overcharges
Section 531.101. Award for Reporting Medicaid Fraud, Abuse, or Overcharges
Section 531.102. Office of Inspector General
Section 531.1022. Peace Officers
Section 531.1023. Compliance With Federal Coding Guidelines
Section 531.1024. Hospital Utilization Reviews and Audits: Provider Education Process
Section 531.1025. Performance Audits and Coordination of Audit Activities
Section 531.103. Interagency Coordination
Section 531.1031. Duty to Exchange Information
Section 531.1032. Office of Inspector General: Criminal History Record Information Check
Section 531.1033. Monitoring of Certain Federal Databases
Section 531.1034. Time to Determine Provider Eligibility; Performance Metrics
Section 531.104. Assisting Investigations by Attorney General
Section 531.105. Fraud Detection Training
Section 531.106. Learning, Neural Network, or Other Technology
Section 531.1061. Fraud Investigation Tracking System
Section 531.1062. Recovery Monitoring System
Section 531.108. Fraud Prevention
Section 531.1081. Integrity of Certain Public Assistance Programs
Section 531.109. Selection and Review of Claims
Section 531.110. Electronic Data Matching Program
Section 531.111. Fraud Detection Technology
Section 531.113. Managed Care Organizations: Special Investigative Units or Contracts
Section 531.1131. Fraud and Abuse Recovery by Certain Persons; Retention of Recovered Amounts
Section 531.1132. Annual Report on Certain Fraud and Abuse Recoveries
Section 531.1135. Managed Care Organizations: Process to Recoup Certain Overpayments
Section 531.114. Financial Assistance Fraud
Section 531.115. Federal Felony Match
Section 531.116. Compliance With Law Prohibiting Solicitation
Section 531.117. Recovery Audit Contractors
Section 531.118. Preliminary Investigations of Allegations of Fraud or Abuse and Fraud Referrals
Section 531.119. Website Posting
Section 531.120. Notice and Informal Resolution of Proposed Recoupment of Overpayment or Debt
Section 531.1201. Appeal of Determination to Recoup Overpayment or Debt
Section 531.1202. Record and Confidentiality of Informal Resolution Meetings
Section 531.1203. Rights of and Provision of Information to Pharmacies Subject to Certain Audits