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.