Bill Text: TX HB2969 | 2017-2018 | 85th Legislature | Comm Sub
Bill Title: Relating to fraud, waste, and abuse in Medicaid and other health and human services programs.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2017-05-09 - Placed on General State Calendar [HB2969 Detail]
Download: Texas-2017-HB2969-Comm_Sub.html
85R23202 MM-D | |||
By: Raymond | H.B. No. 2969 | ||
Substitute the following for H.B. No. 2969: | |||
By: Keough | C.S.H.B. No. 2969 |
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relating to fraud, waste, and abuse in Medicaid and other health and | ||
human services programs. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Sections 531.102(j) and (k), Government Code, | ||
are amended to read as follows: | ||
(j) The office shall prepare a final report on each audit, | ||
inspection, or investigation conducted under this section. The | ||
final report must include: | ||
(1) a summary of the activities performed by the | ||
office in conducting the audit, inspection, or investigation; | ||
(2) a statement regarding whether the audit, | ||
inspection, or investigation resulted in a finding of any | ||
wrongdoing; and | ||
(3) a description of any findings of wrongdoing. | ||
(k) A final report on an audit, inspection, or investigation | ||
is subject to required disclosure under Chapter 552. All | ||
information and materials compiled during the audit, inspection, or | ||
investigation remain confidential and not subject to required | ||
disclosure in accordance with Section 531.1021(g). A confidential | ||
draft report on an audit, inspection, or investigation that | ||
concerns the death of a child may be shared with the Department of | ||
Family and Protective Services. A draft report that is shared with | ||
the Department of Family and Protective Services remains | ||
confidential and is not subject to disclosure under Chapter 552. | ||
SECTION 2. Section 531.1021(g), Government Code, is amended | ||
to read as follows: | ||
(g) All information and materials subpoenaed or compiled by | ||
the office in connection with an audit, inspection, or | ||
investigation or by the office of the attorney general in | ||
connection with a Medicaid fraud investigation are confidential and | ||
not subject to disclosure under Chapter 552, and not subject to | ||
disclosure, discovery, subpoena, or other means of legal compulsion | ||
for their release to anyone other than the office or the attorney | ||
general or their employees or agents involved in the audit, | ||
inspection, or investigation conducted by the office or the | ||
attorney general, except that this information may be disclosed to | ||
the state auditor's office, law enforcement agencies, and other | ||
entities as permitted by other law. | ||
SECTION 3. The heading to Section 531.106, Government Code, | ||
is amended to read as follows: | ||
Sec. 531.106. LEARNING, [ |
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TECHNOLOGY. | ||
SECTION 4. Sections 531.106(a), (c), and (g), Government | ||
Code, are amended to read as follows: | ||
(a) The commission shall use learning, [ |
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or other technology to identify and deter fraud in Medicaid | ||
throughout this state. | ||
(c) The data used for data [ |
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be maintained as an independent subset for security purposes. | ||
(g) Each month, the [ |
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implemented under this section must match vital statistics unit | ||
death records with Medicaid claims filed by a provider. If the | ||
commission determines that a provider has filed a claim for | ||
services provided to a person after the person's date of death, as | ||
determined by the vital statistics unit death records, the | ||
commission shall refer the case for investigation to the | ||
commission's office of inspector general. | ||
SECTION 5. Section 531.1061(b), Government Code, is amended | ||
to read as follows: | ||
(b) For each case of suspected fraud, abuse, or insufficient | ||
quality of care identified by the [ |
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technology required under Section 531.106, the automated fraud | ||
investigation tracking system must: | ||
(1) receive electronically transferred records | ||
relating to the identified case from the [ |
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(2) record the details and monitor the status of an | ||
investigation of the identified case, including maintaining a | ||
record of the beginning and completion dates for each phase of the | ||
case investigation; | ||
(3) generate documents and reports related to the | ||
status of the case investigation; and | ||
(4) generate standard letters to a provider regarding | ||
the status or outcome of an investigation. | ||
SECTION 6. Section 531.1131, Government Code, is amended by | ||
amending Subsections (a), (b), and (c) and adding Subsections | ||
(c-1), (c-2), and (c-3) to read as follows: | ||
(a) If a managed care organization [ |
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with which the managed care organization contracts under Section | ||
531.113(a)(2) discovers fraud or abuse in Medicaid or the child | ||
health plan program, the organization [ |
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(1) immediately submit written notice to [ |
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general and the office of the attorney general in the form and | ||
manner prescribed by the office of inspector general and containing | ||
a detailed description of the fraud or abuse and each payment made | ||
to a provider as a result of the fraud or abuse; | ||
(2) subject to Subsection (b), begin payment recovery | ||
efforts; and | ||
(3) ensure that any payment recovery efforts in which | ||
the organization engages are in accordance with applicable rules | ||
adopted by the executive commissioner. | ||
(b) If the amount sought to be recovered under Subsection | ||
(a)(2) exceeds $100,000, the managed care organization | ||
[ |
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entity described by Subsection (a) may not engage in payment | ||
recovery efforts if, not later than the 10th business day after the | ||
date the organization [ |
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office of inspector general and the office of the attorney general | ||
under Subsection (a)(1), the organization [ |
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a notice from either office indicating that the organization [ |
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or entity is not authorized to proceed with recovery efforts. | ||
(c) A managed care organization may retain one-half of any | ||
money recovered under Subsection (a)(2) by the organization | ||
[ |
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entity described by Subsection (a). The managed care organization | ||
shall remit the remaining amount of money recovered under | ||
Subsection (a)(2) to the commission's office of inspector general. | ||
(c-1) If the commission's office of inspector general | ||
notifies a managed care organization under Subsection (b), proceeds | ||
with recovery efforts, and recovers all or part of the payments the | ||
organization identified as required by Subsection (a)(1), the | ||
organization is entitled to one-half of the amount recovered for | ||
each payment the organization identified after any applicable | ||
federal share is deducted. The managed care organization may not | ||
receive more than one-half of the total amount of money recovered | ||
after any applicable federal share is deducted. | ||
(c-2) Notwithstanding any provision of this section, if the | ||
commission's office of inspector general discovers fraud, waste, or | ||
abuse in Medicaid or the child health plan program in the | ||
performance of its duties, the office may recover payments made to a | ||
provider as a result of the fraud, waste, or abuse as otherwise | ||
provided by this subchapter. | ||
(c-3) With respect to fraud or abuse alleged in any notice | ||
received under Subsection (a), the commission's office of inspector | ||
general shall coordinate with appropriate managed care | ||
organizations to ensure that the office and an organization or an | ||
entity with which an organization contracts under Section | ||
531.113(a)(2) do not both simultaneously pursue recovery efforts | ||
under this section for the same case of fraud, waste, or abuse. | ||
SECTION 7. Section 531.1131, Government Code, as amended by | ||
this Act, applies only to an amount of money recovered on or after | ||
the effective date of this Act. An amount of money recovered before | ||
the effective date of this Act is governed by the law in effect | ||
immediately before that date, and that law is continued in effect | ||
for that purpose. | ||
SECTION 8. If before implementing any provision of this Act | ||
a state agency determines that a waiver or authorization from a | ||
federal agency is necessary for implementation of that provision, | ||
the agency affected by the provision shall request the waiver or | ||
authorization and may delay implementing that provision until the | ||
waiver or authorization is granted. | ||
SECTION 9. This Act takes effect immediately if it receives | ||
a vote of two-thirds of all the members elected to each house, as | ||
provided by Section 39, Article III, Texas Constitution. If this | ||
Act does not receive the vote necessary for immediate effect, this | ||
Act takes effect September 1, 2017. |