By Maxey H.B. No. 875 76R3484 KLA-D 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, 2-12 abuse, or insufficient quality of care under the state Medicaid 2-13 program. 2-14 (b) The recovery monitoring system must: 2-15 (1) monitor the collection of funds resulting from 2-16 settled cases, including: 2-17 (A) recording monetary payments received from a 2-18 provider who has agreed to a monetary payment plan; and 2-19 (B) recording deductions taken through the 2-20 recoupment program from subsequent Medicaid claims filed by the 2-21 provider; and 2-22 (2) provide immediate notice of a provider who has 2-23 agreed to a monetary payment plan or to deductions through the 2-24 recoupment program from subsequent Medicaid claims who fails to 2-25 comply with the settlement agreement, including providing notice of 2-26 a provider who does not make a scheduled payment or who pays less 2-27 than the scheduled amount. 3-1 SECTION 2. Section 22.0252, Human Resources Code, is amended 3-2 by adding Subsections (c) and (d) to read as follows: 3-3 (c) The department shall ensure that the telephone 3-4 collection program attempts to collect reimbursement for all 3-5 identified delinquent payments for which 15 days or more have 3-6 elapsed since the initial notice of delinquency was sent to the 3-7 recipient. 3-8 (d) The department shall use an automated collections system 3-9 to monitor the results of the telephone collection program. The 3-10 system must: 3-11 (1) accept data from the accounts receivable tracking 3-12 system used by the department; 3-13 (2) automate recording tasks performed by a collector, 3-14 including providing access to department records regarding the 3-15 recipient and recording notes and actions resulting from a call 3-16 placed to the recipient; 3-17 (3) automatically generate a letter to a recipient 3-18 following a telephone contact that confirms the action to be taken 3-19 regarding the delinquency; 3-20 (4) monitor the receipt of scheduled payments from a 3-21 recipient for repayment of a delinquency; and 3-22 (5) generate reports regarding the effectiveness of 3-23 individual collectors and of the telephone collection program. 3-24 SECTION 3. Not later than January 1, 2000, the Health and 3-25 Human Services Commission shall: 3-26 (1) implement the automated fraud investigation 3-27 tracking system required by Section 531.1061, Government Code, as 4-1 added by by this Act; and 4-2 (2) award the contract for the purchase and 4-3 installation of commercially available accounting software 4-4 necessary to implement the recovery monitoring system required by 4-5 Section 531.1062, Government Code, as added by this Act, and begin 4-6 using the software. 4-7 SECTION 4. Not later than January 1, 2000, the Department of 4-8 Human Services shall award the contract for the purchase and 4-9 installation of commercially available collections software 4-10 necessary to implement the automated collections system required by 4-11 Section 22.0252, Human Resources Code, as amended by this Act, and 4-12 begin using the software. 4-13 SECTION 5. This Act takes effect September 1, 1999. 4-14 SECTION 6. The importance of this legislation and the 4-15 crowded condition of the calendars in both houses create an 4-16 emergency and an imperative public necessity that the 4-17 constitutional rule requiring bills to be read on three several 4-18 days in each house be suspended, and this rule is hereby suspended.