Bill Text: MS HB1115 | 2016 | Regular Session | Introduced
Bill Title: Medicaid & SNAP programs; make certain revisions regarding.
Sponsorship: Partisan Bill (Republican 1)
Status: (Failed) 2016-02-23 - Died In Committee [HB1115 Detail]
Download: Mississippi-2016-HB1115-Introduced.html
MISSISSIPPI LEGISLATURE
2016 Regular Session
To: Medicaid
By: Representative Brown
House Bill 1115
AN ACT TO PROVIDE THAT RECIPIENTS OF MEDICAID ASSISTANCE WHO ARE DETERMINED TO BE WORK ELIGIBLE SHALL BE REQUIRED TO ENGAGE IN AN ALLOWABLE WORK ACTIVITY; TO PROVIDE THAT MEDICAID ASSISTANCE SHALL NOT BE GIVEN TO ANY PERSON WHO HAS REFUSED TO ACCEPT A REFERRAL OR OFFER OF EMPLOYMENT, TRAINING OR EDUCATION IN WHICH HE OR SHE IS ABLE TO ENGAGE; TO IMPOSE CERTAIN RESTRICTIONS ON THE DEPARTMENT OF HUMAN SERVICES IN ADMINISTERING THE SUPPLEMENTAL NUTRITIONAL ASSISTANCE PROGRAM (SNAP) IN MISSISSIPPI; TO DIRECT THE DEPARTMENT TO SEEK FEDERAL WAIVERS NECESSARY TO ALLOW THE DEPARTMENT TO ENCOURAGE A HEALTHY DIET FOR RECIPIENTS OF SNAP BENEFITS BY LIMITING THE PURCHASE OF FOODS AND BEVERAGES THAT ARE LOW IN NUTRIENTS AND FOODS THAT CONTRIBUTE TO DISEASES SUCH AS HEART DISEASE AND DIABETES; TO DIRECT THE DEPARTMENT TO SEEK FEDERAL WAIVERS NECESSARY TO ALLOW THE DEPARTMENT TO ESTABLISH A PILOT PROGRAM TO PROVIDE INCENTIVES TO PERSONS WHO ARE RECIPIENTS OF BENEFITS OR SERVICES FROM THE DEPARTMENT TO EARN THEIR HIGH SCHOOL EQUIVALENCY CREDENTIAL BY TAKING AND PASSING GED TESTS; TO DIRECT THE DEPARTMENT TO PREPARE A VIDEO IN AN APPROPRIATE MEDIUM FOR PRESENTATION IN THE MAIN OR LOCAL OFFICES IN WHICH TANF AND SNAP BENEFITS ARE PROVIDED BY THE DEPARTMENT THAT PROVIDES INFORMATION ABOUT PROPER NUTRITION, HEALTHY EATING HABITS, AND PREVENTING AND REDUCING OBESITY; TO PROVIDE THAT APPLICANTS FOR AND RECIPIENTS OF TANF AND SNAP BENEFITS MAY VIEW THE VIDEO IN THE MAIN OR LOCAL OFFICE OF THE DEPARTMENT; TO DIRECT THE STATE DEPARTMENT OF HEALTH TO COMPLETE THE CONVERSION OF THE FOOD DELIVERY SYSTEM FOR THE SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN (WIC) FROM A DIRECT DISTRIBUTION SYSTEM TO A RETAIL DELIVERY SYSTEM WITH THE USE OF ELECTRONIC BENEFIT TRANSFER CARDS NOT LATER THAN DECEMBER 31, 2016; TO CREATE THE MEDICAID AND HUMAN SERVICES FRAUD PREVENTION ACT; TO DEFINE CERTAIN TERMS; TO REQUIRE THE DIVISION OF MEDICAID AND THE DEPARTMENT OF HUMAN SERVICES TO JOINTLY ESTABLISH A COMPUTERIZED INCOME, ASSET AND IDENTITY ELIGIBILITY VERIFICATION SYSTEM IN ORDER TO VERIFY ELIGIBILITY, ELIMINATE THE DUPLICATION OF ASSISTANCE, AND DETER WASTE, FRAUD AND ABUSE WITHIN EACH RESPECTIVE ASSISTANCE PROGRAM ADMINISTERED BY THE DIVISION AND THE DEPARTMENT; TO DIRECT THE DIVISION AND THE DEPARTMENT TO JOINTLY ENTER INTO A COMPETITIVELY BID CONTRACT WITH A THIRD-PARTY VENDOR FOR THE PURPOSES OF DEVELOPING THE VERIFICATION SYSTEM; TO REQUIRE THE DIVISION AND THE DEPARTMENT, BEFORE AWARDING BENEFITS OR ASSISTANCE AND ON A QUARTERLY BASIS THEREAFTER, TO IDENTIFY INFORMATION OF EACH RESPECTIVE APPLICANT AND RECIPIENT OF ASSISTANCE AGAINST CERTAIN SPECIFIED INFORMATION DATABASES, AND TO MATCH IDENTITY INFORMATION OF EACH RESPECTIVE APPLICANT AND RECIPIENT OF ASSISTANCE AGAINST CERTAIN SPECIFIED PUBLIC RECORDS; TO REQUIRE APPLICANTS FOR BENEFITS OR ASSISTANCE FROM THE DIVISION OR THE DEPARTMENT TO COMPLETE A COMPUTERIZED IDENTITY AUTHENTICATION PROCESS THAT CONFIRMS THAT THE APPLICANT OWNS THE IDENTITY PRESENTED IN THE APPLICATION, AND TO REQUIRE THE DIVISION OR THE DEPARTMENT TO REVIEW THE RESPECTIVE APPLICANT OR RECIPIENT'S IDENTITY OWNERSHIP USING CERTAIN PROCEDURES; TO PROVIDE THAT IF A DISCREPANCY RESULTS FROM AN APPLICANT OR RECIPIENT'S IDENTITY INFORMATION AND ONE OR MORE OF THE DATABASES OR INFORMATION TOOLS LISTED IN THIS ACT, THE DIVISION OR THE DEPARTMENT WILL REVIEW THE RESPECTIVE APPLICANT OR RECIPIENT'S CASE USING CERTAIN PROCEDURES; TO PROVIDE THAT AFTER REVIEWING CHANGES OR DISCREPANCIES THAT MAY AFFECT PROGRAM ELIGIBILITY, THE DIVISION OR THE DEPARTMENT SHALL REFER SUSPECTED CASES OF FRAUD TO THE ATTORNEY GENERAL'S OFFICE FOR CRIMINAL PROSECUTION, RECOVERY OF IMPROPER PAYMENTS AND COLLECTION OF CIVIL PENALTIES; TO PROVIDE THAT AFTER REVIEWING CHANGES OR DISCREPANCIES THAT MAY AFFECT PROGRAM ELIGIBILITY, THE DIVISION OR THE DEPARTMENT WILL REFER SUSPECTED CASES OF IDENTITY FRAUD TO THE ATTORNEY GENERAL'S OFFICE FOR CRIMINAL PROSECUTION; TO PROVIDE THAT IN CASES OF FRAUD SUBSTANTIATED BY THE DIVISION OR THE DEPARTMENT, UPON CONVICTION, THE STATE WILL REVIEW ALL LEGAL OPTIONS TO REMOVE ENROLLEES FROM OTHER PUBLIC PROGRAMS AND GARNISH WAGES OR STATE INCOME TAX REFUNDS UNTIL THE STATE RECOVERS AN EQUAL AMOUNT OF BENEFITS OR ASSISTANCE FRAUDULENTLY CLAIMED; AND FOR RELATED PURPOSES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:
SECTION 1. Recipients of Medicaid assistance shall be subject to the following requirements after the Division of Medicaid has received any necessary federal waivers to allow their implementation:
(a) If the person applying for or receiving Medicaid assistance is work eligible, as determined by the division, the person shall be required to engage in an allowable work activity once the division determines the person is determined work eligible, or once the person has received Medicaid assistance for twenty-four (24) months, whether or not consecutive, whichever is earlier. Medicaid assistance shall not be given to any person to whom this section applies who fails without good cause to comply with the employability development plan prepared by the division for the person, or who has refused to accept a referral or offer of employment, training or education in which he or she is able to engage.
(b) The division shall implement the work requirements for Medicaid recipients in the same manner as the Department of Human Services implements work requirements for TANF recipients under Section 43-17-5(6). All of the provisions of Section 43-17-5(6) shall be applicable to Medicaid recipients regarding work requirements, exemptions from work requirements, allowable work activities, and penalties for refusing to participate in work requirements to the same extent as if the Medicaid recipients were recipients of TANF benefits under those provisions.
SECTION 2. In administering the Supplemental Nutritional Assistance Program (SNAP) in Mississippi, the Department of Human Services shall be subject to the following restrictions:
(a) The department shall not seek, apply for, accept or renew any waiver of the work requirements established for SNAP recipients under 7 USC Section 2015(o).
(b) The department shall not grant categorical eligibility for SNAP benefits under 7 USC Section 2014(a) for any noncash, in-kind or other benefit unless expressly required by federal law.
(c) The department shall not increase the gross income standards of eligibility for SNAP benefits above the standards specified in 7 USC Section 2014(c) unless expressly required by federal law, and shall not grant categorical eligibility exempting households from the gross income standards requirements for any noncash, in-kind or other benefit unless expressly required by federal law.
(d) The department shall not increase the financial resource limit standards of eligibility for SNAP benefits above the standards specified in 7 USC Section 2014(g)(1) unless expressly required by federal law, and shall not grant categorical eligibility exempting households from the financial resource limits for any noncash, in-kind or other benefit unless expressly required by federal law.
SECTION 3. The Mississippi Department of Human Services shall seek waivers from federal law and regulations from the United States Department of Health and Human Services and the United States Department of Agriculture waivers that are necessary
to allow the Mississippi Department of Human Services to encourage a healthy diet for recipients of Supplemental Nutrition Assistance Program (SNAP) benefits by limiting the purchase of foods and beverages that are low in nutrients and foods that contribute to diseases such as heart disease and diabetes.
SECTION 4. The Mississippi Department of Human Services shall seek waivers from federal law and regulations from the United States Department of Health and Human Services that are necessary to allow the Mississippi Department of Human Services to establish a pilot program to provide incentives to persons who are recipients of benefits or services from the Department of Human Services to earn their high school equivalency credential by taking and passing General Educational Development (GED) tests.
SECTION 5. The Mississippi Department of Human Services, in cooperation with the State Department of Health, shall prepare a video in an appropriate medium for presentation in the main or local offices in which Temporary Assistance for Needy Families (TANF) benefits and Supplemental Nutrition Assistance Program (SNAP) benefits are provided by the department that provides information about proper nutrition, healthy eating habits, and preventing and reducing obesity. Applicants for and recipients of TANF and SNAP benefits may view the video in the main or local office of the department.
SECTION 6. Not later than December 31, 2016, the State Department of Health shall complete the conversion of the food delivery system for the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) from a direct distribution system, in which participants obtain their supplemental food packages at state-run food centers, to a retail delivery system, in which the participants obtain their supplemental food packages by using electronic benefit transfer cards at authorized retailers.
SECTION 7. Section 7 through 15 of this act shall be known and may be cited as the Medicaid and Human Services Fraud Prevention Act.
SECTION 8. Definitions. For the purposes of Section 7 through 15 of this act, the following terms shall be defined as follows, unless the context otherwise requires:
(a) "Agency" means the Division of Medicaid or the Department of Human Services, as the case may be.
(b) "Identity information" means an applicant or recipient's full name, aliases, date of birth, address, Social Security number and other related information.
SECTION 9. Establishment of enhanced eligibility verification system. (1) The Division of Medicaid and the Department of Human Services shall jointly establish a computerized income, asset and identity eligibility verification system in order to verify eligibility, eliminate the duplication of assistance, and deter waste, fraud and abuse within each respective assistance program administered by the Division of Medicaid and the Department of Human Services.
(2) The Division of Medicaid and the Department of Human Services shall jointly enter into a competitively bid contract with a third-party vendor for the purposes of developing a system by which to verify the income, asset and identity eligibility of applicants to prevent fraud, misrepresentation and inadequate documentation when determining an applicant's eligibility for assistance before the distribution of benefits or granting of assistance, periodically between eligibility redeterminations, and during eligibility redeterminations and reviews, as prescribed in this section. The Division of Medicaid and the Department of Human Services may also jointly contract with a vendor to provide information to facilitate reviews of recipient eligibility conducted by the Division of Medicaid and the Department of Human Services.
(3) When the Division of Medicaid and the Department of Human Services enter into a contract with a third-party vendor for the purposes of carrying out Section 7 through 15 of this act, the vendor, in partnership with the Division of Medicaid and the Department of Human Services, shall be required by contract to establish annualized savings realized from implementation of the verification system and savings shall exceed the total yearly cost to the state for implementing the verification system.
(4) When the Division of Medicaid and the Department of Human Services enter into a contract with a third-party vendor, the payment structure shall be based on a per-applicant rate and a performance bonus for achieving above a predetermined rate of success of identifying waste, fraud and abuse.
(5) To avoid any conflict of interest, when the Division of Medicaid and the Department of Human Services enter into a contract with a third-party vendor, that primary vendor may not currently or will not be allowed to bid on or be awarded a state contract to run enrollment services.
(6) If the Division of Medicaid and the Department of Human Services are unable to jointly enter into a contract with a third-party vendor within twelve (12) months after the effective date of this act, then the Department of Information Technology Services shall enter into a contract with a third-party vendor on behalf of the Division of Medicaid and the Department of Human Services under this section.
(7) Nothing in Section 7 through 15 of this act shall preclude the agency from continuing to conduct additional eligibility verification processes, not detailed in Section 7 through 15 of this act, that are currently in practice.
SECTION 10. Enhanced eligibility verification process. (1) All applications for benefits or assistance must be processed within a ten-day period or the minimum required by federal law. Before awarding benefits or assistance and on a quarterly basis thereafter, the agency shall identity information of each respective applicant and recipient of assistance from the agency against the following:
(a) Earned and unearned income information maintained by the Internal Revenue Service;
(b) Employer weekly, monthly, and/or quarterly reports of income and unemployment insurance payment information maintained by the Department of Employment Security;
(c) Earned income information maintained by the Social Security Administration;
(d) Immigration status information maintained by United States Citizenship and Immigration Services;
(e) Death register information maintained by the Social Security Administration;
(f) Prisoner information maintained by the Social Security Administration;
(g) Public housing and Section 8 Housing Assistance payment information maintained by the United States Department of Housing and Urban Development;
(h) National fleeing felon information maintained by the Federal Bureau of Investigation;
(i) Wage reporting and similar information maintained by states contiguous to this state;
(j) Beneficiary records and earnings information maintained by the Social Security Administration in its Beneficiary and Earnings Data Exchange (BENDEX) database;
(k) Earnings and pension information maintained by the Social Security Administration in its Beneficiary Earnings Exchange Record System (BEERS) database;
(l) Employment information maintained by the Department of Employment Security;
(m) Employment information maintained by the United States Department of Health and Human Services in its National Directory of New Hires (NDNH) database;
(n) Supplemental Security Income information maintained by the Social Security Administration in its SSI State Data Exchange (SDX) database;
(o) Veterans' benefits information maintained by the United States Department of Health and Human Services, in coordination with the State Department of Health and State Veterans Affairs Board, in the federal Public Assistance Reporting Information System (PARIS) database;
(p) Child care services information maintained by the Department of Human Services;
(q) Utility payments information maintained by the state under the Low Income Home Energy Assistance Program;
(r) Emergency utility payment information maintained by the state or local entities;
(s) A database of all persons who currently hold a license, permit or certificate from any state agency the cost of which exceeds Five Hundred Dollars ($500.00);
(t) Income and employment information maintained by Child Support Unit of the Department of Human Services and the United States Department of Health and Human Services' Office of Child Support Enforcement;
(u) Earnings and pension information maintained by Public Employees' Retirement System;
(v) Any existing real-time database of persons currently receiving benefits or assistance in other states, such as the National Accuracy Clearinghouse; and
(w) A database that is substantially similar to or a successor of a database established in Section 7 through 15 of this act.
(2) Before awarding benefits or assistance and on a quarterly basis, the agency shall match identity information of each respective applicant and recipient of assistance from the agency against, at minimum, the following public records:
(a) A nationwide public records data source of physical asset ownership such as real property, automobiles, watercraft, aircraft and luxury vehicles, or any other vehicle owned by the applicant and recipient of assistance;
(b) A nationwide public records data source of incarcerated individuals;
(c) A nationwide best-address and driver's license data source to verify individuals are residents of the state;
(d) A comprehensive public records database that identifies potential identity fraud or identity theft that can closely associate name, social security number, date of birth, phone and address information;
(e) Outstanding default or arrest warrant information maintained by the Mississippi Justice Information System; and
(f) A database that is substantially similar to or a successor of a database established in Section 7 through 15 of this act.
SECTION 11. Enhanced identity authentication process. (1) Before awarding benefits or assistance, applicants must complete a computerized identity authentication process that confirms that the applicant owns the identity presented in the application. The agency shall review the respective applicant or recipient's identity ownership using the following procedures:
(a) Provide a knowledge-based quiz consisting of financial or personal questions. The quiz must provide support for nonbanked or under-banked applicants who do not have an established credit history.
(b) Require the quiz for applications submitted through all channels, including online, in-person and via phone.
SECTION 12. Discrepancies and case review. (1) If a discrepancy results from an applicant or recipient's identity information and one or more of the databases or information tools listed under Section 10 or Section 11 of this act, the agency shall review the respective applicant or recipient's case using the following procedures:
(a) If the information discovered does not result in the agency finding a discrepancy or change in an applicant's or recipient's circumstances that may affect eligibility, the agency shall take no further action.
(b) If the information discovered under Section 10 or Section 11 of this act results in the agency finding a discrepancy or change in a recipient's circumstances that may affect eligibility, the agency shall promptly redetermine eligibility after receiving that information.
(c) (i) If the information discovered under Section 10 or Section 11 of this act results in the agency finding a discrepancy or change in an applicant's or recipient's circumstances that may affect eligibility, the applicant or recipient shall be given an opportunity to explain the discrepancy; however, self-declarations by applicants or recipients shall not be accepted as verification of categorical and financial eligibility during eligibility evaluations, reviews and redeterminations.
(ii) The agency shall provide written notice to the applicant or recipient, which shall describe in sufficient detail the circumstances of the discrepancy or change, the manner in which the applicant or recipient may respond, and the consequences of failing to take action. The applicant or recipient shall have thirty (30) days, or the minimum required by state or federal law, to respond in an attempt to resolve the discrepancy or change. The explanation provided by the recipient or applicant shall be given in writing. After receiving the explanation, the agency may request additional documentation if it determines that there is risk of fraud, misrepresentation, or inadequate documentation.
(d) If the applicant or recipient does not respond to the notice, the agency shall deny or discontinue assistance for failure to cooperate, in which case the agency shall provide notice of intent to deny or discontinue assistance. Eligibility for assistance shall not be established or reestablished until the discrepancy or change has been resolved.
(e) If an applicant or recipient responds to the notice and disagrees with the findings of the match between his or her identity information and one or more databases or information tools listed under Section 7 through 15 of this act, the agency shall reinvestigate the matter. If the agency finds that there has been an error, the agency shall take immediate action to correct it and no further action shall be taken. If, after an investigation, the agency determines that there is no error, the agency shall determine the effect on the applicant's or recipient's case and take appropriate action. Written notice of the respective agency's action shall be given to the applicant or recipient.
(f) If the applicant or recipient agrees with the findings of the match between the applicant's or recipient's identity information and one or more databases or information tools listed under Section 7 through 15 of this act, the agency shall determine the effect on the applicant or recipient's case and take appropriate action. Written notice of the agency's action shall be given to the applicant or recipient. In no case shall the agency discontinue assistance as a result of a match between the applicant's or recipient's identity information and one or more databases or information tools listed under Section 7 through 15 of this act until the applicant or recipient has been given notice of the discrepancy and the opportunity to respond as required under Section 7 through 15 of this act.
(2) The Division of Medicaid and the Department of Human Services shall jointly promulgate rules and regulations necessary for the purposes of carrying out this act.
SECTION 13. Referrals for fraud, misrepresentation, or inadequate documentation. (1) After reviewing changes or discrepancies that may affect program eligibility, the agency shall refer suspected cases of fraud to the Attorney General's office for criminal prosecution, recovery of improper payments and collection of civil penalties.
(2) After reviewing changes or discrepancies that may affect program eligibility, the agency shall refer suspected cases of identity fraud to the Attorney General's office for criminal prosecution.
(3) In cases of fraud substantiated by the agency, upon conviction, the state shall review all legal options to remove enrollees from other public programs and garnish wages or state income tax refunds until the state recovers an equal amount of benefits or assistance fraudulently claimed.
(4) After reviewing changes or discrepancies that may affect program eligibility, the agency shall refer suspected cases of fraud, misrepresentation or inadequate documentation to appropriate agencies or departments for review of eligibility discrepancies in other public programs. This also includes cases where an individual is determined to be no longer eligible for the original program.
SECTION 14. Implementation date and reporting. (1) Section 7 through 15 of this act shall be implemented twelve (12) months following the effective date of this act.
(2) Six (6) months after the implementation of Section 7 through 15 of this act, and quarterly thereafter, the agency shall provide a written report to the Governor and the Legislature detailing the effectiveness and general findings of the eligibility verification system, including the number of cases reviewed, the number of case closures, the number of referrals for criminal prosecution, recovery of improper payment, collection of civil penalties, the outcomes of cases referred to Attorney General's office under Section 7 through 15 of this act, and the savings that have resulted from the system.
SECTION 15. Transparency in Medicaid. Following the precedent set by Medicare, the Division of Medicaid shall release data that includes, but is not limited to, the following: the physician's name and office locations; a provider's National Provider Identifier (NPI); the type of service provided by Healthcare Common Procedure Coding System (HCPCS) code; and whether the service was performed in a facility or office setting. This public data also shall include the number of services, average submitted charges, average allowed amount, average Medicaid payment, and a count of unique beneficiaries treated.
SECTION 16. This act shall take effect and be in force from and after July 1, 2016.
