Senate
File
334
-
Reprinted
SENATE
FILE
334
BY
COMMITTEE
ON
LABOR
AND
BUSINESS
RELATIONS
(SUCCESSOR
TO
SSB
1131)
(As
Amended
and
Passed
by
the
Senate
April
1,
2019
)
A
BILL
FOR
An
Act
relating
to
public
assistance
program
oversight.
1
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
2
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Section
1.
PUBLIC
ASSISTANCE
PROGRAMS
——
VERIFICATION
OF
1
APPLICANT
ELIGIBILITY.
2
1.
The
department
of
human
services
shall
implement
an
3
eligibility
verification
system
for
public
assistance
programs
4
to
verify
the
eligibility
of
an
individual
who
is
an
applicant
5
for
any
such
program.
The
information
to
be
verified
and
6
sources
to
be
examined
for
each
individual
shall
include
but
7
are
not
limited
to
all
of
the
following:
8
a.
Earned
and
unearned
income.
9
b.
Employment
status
and
changes
in
employment.
10
c.
Immigration
status.
11
d.
Residency
status,
including
a
nationwide
best-address
12
source
to
verify
that
individuals
are
residents
of
the
state.
13
e.
Enrollment
status
in
other
state-administered
public
14
assistance
programs.
15
f.
Incarceration
status.
16
g.
Death
records.
17
h.
Enrollment
status
in
public
assistance
programs
outside
18
of
this
state.
19
i.
Records
of
any
potential
identity
fraud
or
identity
20
theft.
21
2.
The
department
of
human
services
shall
enter
into
a
22
memorandum
of
understanding
with
any
department,
division,
23
bureau,
section,
unit,
or
any
other
subunit
of
a
department,
as
24
necessary,
to
obtain
the
information
specified
in
subsection
1.
25
3.
The
department
may
contract
with
a
third-party
26
vendor
to
provide
any
or
all
of
the
information
specified
27
in
subsection
1.
Specifically,
the
department
may
contract
28
with
a
third-party
consumer
reporting
agency,
as
defined
by
29
the
federal
Fair
Credit
Reporting
Act,
15
U.S.C.
§1681a,
for
30
the
purpose
of
obtaining
real-time
employment
and
income
31
information
as
specified
in
subsection
1.
Such
contract
shall
32
not
require
the
third-party
vendor
to
determine
applicant
33
or
enrollee
eligibility.
Any
such
contract
shall
include
a
34
provision
that
ensures
that
annualized
savings
to
the
state
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exceed
the
contract’s
total
annual
cost
to
the
state,
and
that
1
the
cost
of
a
third-party
vendor
to
provide
the
information
is
2
less
than
the
cost
to
the
department
to
internally
obtain
and
3
compile
the
information.
4
4.
Nothing
in
this
section
shall
preclude
the
department
5
of
human
services
from
receiving,
reviewing,
or
verifying
6
additional
information
related
to
the
eligibility
of
an
7
individual
not
specified
in
this
section
or
from
contracting
8
with
a
third-party
vendor
to
provide
additional
information
not
9
specified
in
this
section.
10
5.
For
the
purposes
of
this
section,
“public
assistance
11
program”
shall
include
but
is
not
limited
to
the
Medicaid
12
program,
the
family
investment
program
(FIP),
and
the
13
supplemental
nutrition
assistance
program
(SNAP).
14
Sec.
2.
PUBLIC
ASSISTANCE
PROGRAMS
——
REAL-TIME
ELIGIBILITY
15
MONITORING.
16
1.
The
department
of
human
services
shall
implement
a
17
real-time
eligibility
system
that
allows
the
department
to
18
obtain
and
review
all
of
the
following
information
and
sources
19
to
determine
ongoing
eligibility
of
an
enrollee
in
a
public
20
assistance
program:
21
a.
Earned
and
unearned
income.
22
b.
Employment
status
and
changes
in
employment.
23
c.
Residency
status.
24
d.
Enrollment
status
in
other
state-administered
public
25
assistance
programs.
26
e.
Financial
resources.
27
f.
Incarceration
status.
28
g.
Death
records.
29
h.
Lottery
winnings.
30
i.
Enrollment
status
in
public
assistance
programs
outside
31
of
the
state.
32
2.
The
department
of
human
services
shall
enter
into
a
33
memorandum
of
understanding
with
any
department,
division,
34
bureau,
section,
unit,
or
any
other
subunit
of
a
department
to
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obtain
the
information
specified
in
subsection
1.
1
3.
The
department
may
contract
with
a
third-party
2
vendor
to
provide
any
or
all
of
the
information
specified
3
in
subsection
1.
Specifically,
the
department
may
contract
4
with
a
third-party
consumer
reporting
agency,
as
defined
by
5
the
federal
Fair
Credit
Reporting
Act,
15
U.S.C.
§1681a,
for
6
the
purpose
of
obtaining
real-time
employment
and
income
7
information
as
specified
in
subsection
1.
Such
contract
shall
8
not
require
the
third-party
vendor
to
determine
applicant
9
or
enrollee
eligibility.
Any
such
contract
shall
include
a
10
provision
that
ensures
that
annualized
savings
to
the
state
11
exceed
the
contract’s
total
annual
cost
to
the
state,
and
that
12
the
cost
of
a
third-party
vendor
to
provide
the
information
is
13
less
than
the
cost
to
the
department
to
internally
obtain
and
14
compile
the
information.
15
4.
The
department
shall
explore
opportunities
to
join
16
existing
multistate
collaborations
to
identify
individuals
who
17
are
also
enrolled
in
public
assistance
programs
outside
of
the
18
state,
including
the
national
accuracy
clearinghouse.
19
5.
Nothing
in
this
section
shall
preclude
the
department
20
of
human
services
from
receiving
or
reviewing
additional
21
information
related
to
the
eligibility
of
an
individual
22
not
specified
in
this
section
or
from
contracting
with
a
23
third-party
vendor
to
provide
additional
information
not
24
specified
in
this
section.
25
6.
If
the
department
receives
information
about
an
enrollee
26
in
a
public
assistance
program
that
indicates
a
potential
27
change
or
discrepancy
in
circumstances
that
may
affect
the
28
individual’s
eligibility
for
that
public
assistance
program,
29
the
department
shall
review
the
individual’s
circumstances
and
30
respond
appropriately,
as
follows:
31
a.
If
the
review
does
not
result
in
the
department
32
confirming
any
discrepancy
or
change
in
an
individual’s
33
circumstances
that
may
affect
eligibility,
the
department
shall
34
take
no
further
action.
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b.
If
the
review
results
in
the
department
finding
1
a
potential
discrepancy
or
change
in
the
individual’s
2
circumstances
that
may
affect
eligibility,
the
department
shall
3
promptly
notify
the
individual.
4
(1)
The
department
shall
provide
written
notice
to
the
5
enrollee,
which
shall
describe
in
sufficient
detail
the
6
circumstances
of
the
potential
discrepancy
or
change,
the
7
manner
in
which
the
enrollee
may
respond,
and
the
consequences
8
of
failing
to
take
action.
However,
a
self-declaration
of
an
9
enrollee
alone
shall
not
be
accepted
as
verification
to
refute
10
the
information.
11
(2)
The
enrollee
shall
have
thirty
business
days
to
respond
12
to
the
department
in
writing,
to
provide
information
to
13
refute
and
resolve
the
potential
discrepancy
or
change.
After
14
receiving
the
enrollee’s
written
response,
the
department
may
15
request
additional
documentation
if
the
department
determines
16
that
the
documentation
is
inadequate
or
that
a
risk
of
fraud
or
17
misrepresentation
exists.
A
self-declaration
of
an
enrollee
18
refuting
the
information
shall
not,
alone,
constitute
a
19
refutation
of
the
potential
discrepancy
or
change.
20
(3)
If
the
enrollee
does
not
respond
to
the
written
21
notice
in
a
timely
manner,
the
department
shall
provide
22
notice
to
terminate
the
individual’s
enrollment,
based
upon
23
the
individual’s
failure
to
cooperate,
and
shall
terminate
24
the
individual’s
enrollment
in
any
applicable
public
25
assistance
program.
The
individual’s
eligibility
shall
not
be
26
reestablished
until
the
discrepancy
or
change
is
resolved.
27
(4)
If
the
enrollee
responds
to
the
written
notice
in
a
28
timely
manner
and
disagrees
with
the
findings,
the
department
29
shall
reevaluate
the
enrollee’s
situation.
If
the
department
30
determines
through
the
reevaluation
that
the
information
upon
31
which
the
discrepancy
or
change
was
based
is
in
error,
the
32
department
shall
take
immediate
action
to
correct
the
error
and
33
no
further
action
on
the
enrollee’s
eligibility
status
shall
be
34
taken.
If
the
department
affirms
through
the
reevaluation
that
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a
discrepancy
or
change
exists,
the
department
shall
determine
1
the
effect
on
the
enrollee’s
eligibility
and
take
appropriate
2
action.
Written
notice
of
the
results
of
the
department’s
3
reevaluation
and
the
actions
to
be
taken
shall
be
provided
to
4
the
individual.
5
(5)
If
the
enrollee
responds
to
the
written
notice
in
a
6
timely
manner
and
agrees
with
the
findings,
the
department
7
shall
determine
the
effect
on
the
enrollee’s
circumstances
and
8
take
appropriate
action.
Written
notice
of
the
actions
to
be
9
taken
by
the
department
shall
be
provided
to
the
individual.
10
7.
For
the
purposes
of
this
section:
11
a.
“Public
assistance
program”
shall
include
but
is
not
12
limited
to
Medicaid,
the
family
investment
program
(FIP),
and
13
the
supplemental
nutrition
assistance
program
(SNAP).
14
b.
“Real-time
eligibility
system”
means
an
electronic,
15
on-demand
system
that
allows
verification
of
all
applicable
16
public
assistance
program
eligibility
information
based
on
the
17
most
recent
information
available
to
the
department
through
18
memoranda
of
understanding,
contracts,
or
other
necessary
19
agreements.
20
Sec.
3.
REPORTING
OF
FRAUD.
If,
through
the
department’s
21
activities
under
this
Act,
the
department
discovers
potential
22
fraudulent
activity,
the
department
shall
report
its
findings
23
and
any
supportive
information
to
the
department
of
inspections
24
and
appeals
for
review.
25
Sec.
4.
ADMINISTRATION
——
REPORTING.
26
1.
The
department
of
human
services
shall
adopt
rules
27
pursuant
to
chapter
17A
to
administer
this
Act.
28
2.
The
department
shall
submit
a
report
to
the
governor
29
and
the
general
assembly
by
January
15,
2022,
and
by
January
30
15
annually
thereafter,
detailing
the
impact
of
verification
31
of
applicant
eligibility
for
public
assistance
programs
and
32
real-time
eligibility
monitoring
of
recipients
of
public
33
assistance
programs
as
provided
in
this
Act.
The
reports
shall
34
include
the
number
of
cases
reviewed,
the
number
of
cases
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closed,
the
number
of
fraud
investigation
referrals
made,
and
1
the
amount
of
savings
and
cost
avoidance
realized
from
the
2
provisions
of
the
Act.
3
3.
The
department
of
human
services
shall
submit,
to
the
4
centers
for
Medicare
and
Medicaid
services
(CMS)
of
the
United
5
States
department
of
health
and
human
services
any
Medicaid
6
state
plan
amendment
or
waiver
request
necessary
to
administer
7
this
Act.
8
Sec.
5.
IMPLEMENTATION.
9
1.
The
provisions
of
this
Act
requiring
approval
of
a
10
Medicaid
state
plan
amendment
or
waiver
shall
be
implemented
11
upon
receipt
of
such
federal
approval.
12
2.
The
provisions
of
this
Act
not
requiring
approval
of
a
13
Medicaid
state
plan
amendment
or
waiver
shall
be
implemented
14
on
January
1,
2021.
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