76R9730 KLA-D
By Maxey H.B. No. 875
Substitute the following for H.B. No. 875:
By Maxey C.S.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. Section 531.102, Government Code, is amended by
1-6 adding Subsection (e) to read as follows:
1-7 (e) The commission by rule shall establish procedures to
1-8 provide to a person who is the subject of an investigation for
1-9 Medicaid or welfare fraud or abuse an opportunity to review and
1-10 correct inaccuracies in the information on which the investigation
1-11 is based.
1-12 SECTION 2. Subchapter C, Chapter 531, Government Code, is
1-13 amended by adding Sections 531.1061 and 531.1062 to read as
1-14 follows:
1-15 Sec. 531.1061. FRAUD INVESTIGATION TRACKING SYSTEM. (a) The
1-16 commission shall use an automated fraud investigation tracking
1-17 system through the commission's office of investigations and
1-18 enforcement to monitor the progress of an investigation of
1-19 suspected fraud, abuse, or insufficient quality of care under the
1-20 state Medicaid program.
1-21 (b) For each case of suspected fraud, abuse, or insufficient
1-22 quality of care identified by the learning or neural network
1-23 technology required under Section 531.106, the automated fraud
1-24 investigation tracking system must:
2-1 (1) receive electronically transferred records
2-2 relating to the identified case from the learning or neural network
2-3 technology;
2-4 (2) record the details and monitor the status of an
2-5 investigation of the identified case, including maintaining a
2-6 record of the beginning and completion dates for each phase of the
2-7 case investigation;
2-8 (3) generate documents and reports related to the
2-9 status of the case investigation; and
2-10 (4) generate standard letters to a provider regarding
2-11 the status or outcome of an investigation.
2-12 (c) The commission shall require each health and human
2-13 services agency that performs any aspect of the state Medicaid
2-14 program to participate in the implementation and use of the
2-15 automated fraud investigation tracking system.
2-16 Sec. 531.1062. RECOVERY MONITORING SYSTEM. (a) The
2-17 commission shall use an automated recovery monitoring system to
2-18 monitor the collections process for a settled case of fraud, abuse,
2-19 or insufficient quality of care under the state Medicaid program.
2-20 (b) The recovery monitoring system must:
2-21 (1) monitor the collection of funds resulting from
2-22 settled cases, including:
2-23 (A) recording monetary payments received from a
2-24 provider who has agreed to a monetary payment plan; and
2-25 (B) recording deductions taken through the
2-26 recoupment program from subsequent Medicaid claims filed by the
2-27 provider; and
3-1 (2) provide immediate notice of a provider who has
3-2 agreed to a monetary payment plan or to deductions through the
3-3 recoupment program from subsequent Medicaid claims who fails to
3-4 comply with the settlement agreement, including providing notice of
3-5 a provider who does not make a scheduled payment or who pays less
3-6 than the scheduled amount.
3-7 SECTION 3. Section 22.025, Human Resources Code, is amended
3-8 by adding Subsection (e) to read as follows:
3-9 (e) The department by rule shall establish procedures to
3-10 provide to a person who received in error as determined by the
3-11 department a benefit under the food stamp program or the program of
3-12 financial assistance under Chapter 31 an opportunity to review and
3-13 correct inaccuracies in the information on which that determination
3-14 is based.
3-15 SECTION 4. Section 22.0252, Human Resources Code, is amended
3-16 by adding Subsections (c) and (d) to read as follows:
3-17 (c) The department shall ensure that the telephone
3-18 collection program attempts to collect reimbursement for all
3-19 identified delinquent payments for which 15 days or more have
3-20 elapsed since the initial notice of delinquency was sent to the
3-21 recipient.
3-22 (d) The department shall use an automated collections system
3-23 to monitor the results of the telephone collection program. The
3-24 system must:
3-25 (1) accept data from the accounts receivable tracking
3-26 system used by the department;
3-27 (2) automate recording tasks performed by a collector,
4-1 including providing access to department records regarding the
4-2 recipient and recording notes and actions resulting from a call
4-3 placed to the recipient;
4-4 (3) automatically generate a letter to a recipient
4-5 following a telephone contact that confirms the action to be taken
4-6 regarding the delinquency;
4-7 (4) monitor the receipt of scheduled payments from a
4-8 recipient for repayment of a delinquency; and
4-9 (5) generate reports regarding the effectiveness of
4-10 individual collectors and of the telephone collection program.
4-11 SECTION 5. Not later than January 1, 2000, the Health and
4-12 Human Services Commission shall:
4-13 (1) implement the automated fraud investigation
4-14 tracking system required by Section 531.1061, Government Code, as
4-15 added by this Act; and
4-16 (2) award the contract for the purchase and
4-17 installation of commercially available accounting software
4-18 necessary to implement the recovery monitoring system required by
4-19 Section 531.1062, Government Code, as added by this Act, and begin
4-20 using the software.
4-21 SECTION 6. Not later than January 1, 2000, the Department of
4-22 Human Services shall award the contract for the purchase and
4-23 installation of commercially available collections software
4-24 necessary to implement the automated collections system required by
4-25 Section 22.0252, Human Resources Code, as amended by this Act, and
4-26 begin using the software.
4-27 SECTION 7. This Act takes effect September 1, 1999.
5-1 SECTION 8. The importance of this legislation and the
5-2 crowded condition of the calendars in both houses create an
5-3 emergency and an imperative public necessity that the
5-4 constitutional rule requiring bills to be read on three several
5-5 days in each house be suspended, and this rule is hereby suspended.