Bill Text: CT HB06514 | 2013 | General Assembly | Introduced
Bill Title: An Act Implementing The Recommendations Of The Program Review And Investigations Committee Concerning Medicaid Payment Integrity.
Spectrum: Bipartisan Bill
Status: (Passed) 2013-07-12 - Signed by the Governor [HB06514 Detail]
Download: Connecticut-2013-HB06514-Introduced.html
General Assembly |
Raised Bill No. 6514 | ||
January Session, 2013 |
LCO No. 3669 | ||
*03669_______PRI* | |||
Referred to Committee on PROGRAM REVIEW AND INVESTIGATIONS |
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Introduced by: |
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(PRI) |
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AN ACT IMPLEMENTING THE RECOMMENDATIONS OF THE PROGRAM REVIEW AND INVESTIGATIONS COMMITTEE CONCERNING MEDICAID PAYMENT INTEGRITY.
Be it enacted by the Senate and House of Representatives in General Assembly convened:
Section 1. (NEW) (Effective from passage) (a) On January 1, 2014, and annually thereafter, the Commissioner of Social Services, in consultation with the Chief State's Attorney and the Attorney General, shall submit a joint report, in accordance with the provisions of section 11-4a of the general statutes, to the General Assembly on the state's efforts in the previous fiscal year to prevent and control fraud, abuse and errors in the Medicaid payment system and to recover Medicaid overpayments, except as otherwise required. The joint report shall include a final reconciled and unduplicated accounting of identified, ordered, collected and outstanding Medicaid recoveries from all sources.
(b) The Department of Social Services shall provide information, including, but not limited to:
(1) Data related to Medicaid audits conducted by the department, including: (A) The number of such audits completed by provider type; (B) the amount of overpayments identified due to such audits; (C) the amount of avoided costs identified due to such audits; (D) the amount of overpayments recovered due to such audits; and (E) the number of such audits resulting in referral to the office of the Chief State's Attorney;
(2) Data related to Medicaid program integrity investigations conducted by the department, including: (A) The number of complaints received by source type and reason; (B) the number of investigations, with outcomes for each investigation, completed by source type and provider type; (C) the amount of overpayments identified due to investigations; (D) the amount of overpayments collected due to investigations; (E) the number of investigations resulting in a referral to the office of the Chief State's Attorney; (F) the number of investigations resulting in suspension of Medicaid payments by provider type; and (G) the number of investigations resulting in provider exclusion from the Medicaid program by provider type; and
(3) The amount of overpayments collected by recovery contractors by type of contractor.
(c) The Chief State's Attorney shall provide Medicaid information including, but not limited to: (1) The number of investigations opened by source type; (2) a summary of allegations by provider type; (3) the length of time between case opening and closing; (4) the final disposition of closed cases; (5) the monetary recovery sought and realized by action, including (A) criminal charges, (B) settlements, and (C) judgments; and (6) the number of referrals declined and reason.
(d) The Attorney General shall provide Medicaid information including, but not limited to: (1) The number of investigations opened by source type; (2) a summary of allegations by provider type; (3) the length of time between case opening and closing; (4) the final disposition of closed cases; (5) the monetary recovery sought and realized by action, including (A) civil monetary penalties, (B) settlements, and (C) judgments; and (6) the number of referrals declined and reason.
(e) The joint report shall include third party liability recovery information for the previous five-year period by fiscal year, including, but not limited to: (1) The total number of claims selected for billing by commercial health insurance and Medicare; (2) the total amount billed for such claims; (3) the number of claims where recovery occurred; (4) the actual amount collected; (5) the number of files updated with third party insurance information; and (6) the estimated cost avoidance in the future related to updated files.
(f) The joint report shall include: (1) Detailed and unit specific performance standards, benchmarks and metrics; (2) projected cost savings for the following fiscal year; (3) new initiatives taken to prevent and detect overpayments; and (4) policy recommendations necessary to prevent or recover overpayments and deter and detect fraud. All such policy recommendations shall include a detailed fiscal analysis, including estimated (A) implementation costs, (B) savings, and (C) return on investment.
(g) The Commissioner of Social Services, in consultation with the Chief State's Attorney and the Attorney General, shall submit the joint report, in accordance with the provisions of section 11-4a of the general statutes, to the joint standing committees of the General Assembly having cognizance of matters relating to human services and appropriations and the budgets of state agencies.
This act shall take effect as follows and shall amend the following sections: | ||
Section 1 |
from passage |
New section |
Statement of Purpose:
To implement the recommendations of the Program Review and Investigations Committee regarding the establishment of annual reporting on Medicaid payment system integrity efforts.
[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not underlined.]