By Maxey H.B. No. 875
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to increasing collections for cases of fraud in the
1-3 Medicaid, financial assistance, and food stamp programs.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Subchapter C, Chapter 531, Government Code, is
1-6 amended by adding Sections 531.1061 and 531.1062 to read as
1-7 follows:
1-8 Sec. 531.1061. FRAUD INVESTIGATION TRACKING SYSTEM. (a) The
1-9 commission shall use an automated fraud investigation tracking
1-10 system through the commission's office of investigations and
1-11 enforcement to monitor the progress of an investigation of
1-12 suspected fraud, abuse, or insufficient quality of care under the
1-13 state Medicaid program.
1-14 (b) For each case of suspected fraud, abuse, or insufficient
1-15 quality of care identified by the learning or neural network
1-16 technology required under Section 531.106, the automated fraud
1-17 investigation tracking system must:
1-18 (1) receive electronically transferred records
1-19 relating to the identified case from the learning or neural network
1-20 technology;
1-21 (2) record the details and monitor the status of an
1-22 investigation of the identified case, including maintaining a
1-23 record of the beginning and completion dates for each phase of the
1-24 case investigation;
2-1 (3) generate documents and reports related to the
2-2 status of the case investigation; and
2-3 (4) generate standard letters to a provider regarding
2-4 the status or outcome of an investigation.
2-5 (c) The commission shall require each health and human
2-6 services agency that performs any aspect of the state Medicaid
2-7 program to participate in the implementation and use of the
2-8 automated fraud investigation tracking system.
2-9 Sec. 531.1062. RECOVERY MONITORING SYSTEM. (a) The
2-10 commission shall use an automated recovery monitoring system to
2-11 monitor the collections process for a settled case of fraud, abuse,
2-12 or insufficient quality of care under the state Medicaid program.
2-13 (b) The recovery monitoring system must:
2-14 (1) monitor the collection of funds resulting from
2-15 settled cases, including:
2-16 (A) recording monetary payments received from a
2-17 provider who has agreed to a monetary payment plan; and
2-18 (B) recording deductions taken through the
2-19 recoupment program from subsequent Medicaid claims filed by the
2-20 provider; and
2-21 (2) provide immediate notice of a provider who has
2-22 agreed to a monetary payment plan or to deductions through the
2-23 recoupment program from subsequent Medicaid claims who fails to
2-24 comply with the settlement agreement, including providing notice of
2-25 a provider who does not make a scheduled payment or who pays less
2-26 than the scheduled amount.
2-27 SECTION 2. Section 22.0252, Human Resources Code, is amended
3-1 by adding Subsections (c) and (d) to read as follows:
3-2 (c) The department shall ensure that the telephone
3-3 collection program attempts to collect reimbursement for all
3-4 identified delinquent payments for which 15 days or more have
3-5 elapsed since the initial notice of delinquency was sent to the
3-6 recipient.
3-7 (d) The department shall use an automated collections system
3-8 to monitor the results of the telephone collection program. The
3-9 system must:
3-10 (1) accept data from the accounts receivable tracking
3-11 system used by the department;
3-12 (2) automate recording tasks performed by a collector,
3-13 including providing access to department records regarding the
3-14 recipient and recording notes and actions resulting from a call
3-15 placed to the recipient;
3-16 (3) automatically generate a letter to a recipient
3-17 following a telephone contact that confirms the action to be taken
3-18 regarding the delinquency;
3-19 (4) monitor the receipt of scheduled payments from a
3-20 recipient for repayment of a delinquency; and
3-21 (5) generate reports regarding the effectiveness of
3-22 individual collectors and of the telephone collection program.
3-23 SECTION 3. Not later than January 1, 2000, the Health and
3-24 Human Services Commission shall:
3-25 (1) implement the automated fraud investigation
3-26 tracking system required by Section 531.1061, Government Code, as
3-27 added by this Act; and
4-1 (2) award the contract for the purchase and
4-2 installation of commercially available accounting software
4-3 necessary to implement the recovery monitoring system required by
4-4 Section 531.1062, Government Code, as added by this Act, and begin
4-5 using the software.
4-6 SECTION 4. Not later than January 1, 2000, the Department of
4-7 Human Services shall award the contract for the purchase and
4-8 installation of commercially available collections software
4-9 necessary to implement the automated collections system required by
4-10 Section 22.0252, Human Resources Code, as amended by this Act, and
4-11 begin using the software.
4-12 SECTION 5. This Act takes effect September 1, 1999.
4-13 SECTION 6. The importance of this legislation and the
4-14 crowded condition of the calendars in both houses create an
4-15 emergency and an imperative public necessity that the
4-16 constitutional rule requiring bills to be read on three several
4-17 days in each house be suspended, and this rule is hereby suspended.