1-1 By: Maxey (Senate Sponsor - Zaffirini) H.B. No. 875 1-2 (In the Senate - Received from the House April 9, 1999; 1-3 April 12, 1999, read first time and referred to Committee on Human 1-4 Services; April 29, 1999, reported adversely, with favorable 1-5 Committee Substitute by the following vote: Yeas 5, Nays 0; 1-6 April 29, 1999, sent to printer.) 1-7 COMMITTEE SUBSTITUTE FOR H.B. No. 875 By: Zaffirini 1-8 A BILL TO BE ENTITLED 1-9 AN ACT 1-10 relating to increasing collections for cases of fraud in the 1-11 Medicaid, financial assistance, and food stamp programs. 1-12 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-13 SECTION 1. Subchapter C, Chapter 531, Government Code, is 1-14 amended by adding Sections 531.1061 and 531.1062 to read as 1-15 follows: 1-16 Sec. 531.1061. FRAUD INVESTIGATION TRACKING SYSTEM. (a) The 1-17 commission shall use an automated fraud investigation tracking 1-18 system through the commission's office of investigations and 1-19 enforcement to monitor the progress of an investigation of 1-20 suspected fraud, abuse, or insufficient quality of care under the 1-21 state Medicaid program. 1-22 (b) For each case of suspected fraud, abuse, or insufficient 1-23 quality of care identified by the learning or neural network 1-24 technology required under Section 531.106, the automated fraud 1-25 investigation tracking system must: 1-26 (1) receive electronically transferred records 1-27 relating to the identified case from the learning or neural network 1-28 technology; 1-29 (2) record the details and monitor the status of an 1-30 investigation of the identified case, including maintaining a 1-31 record of the beginning and completion dates for each phase of the 1-32 case investigation; 1-33 (3) generate documents and reports related to the 1-34 status of the case investigation; and 1-35 (4) generate standard letters to a provider regarding 1-36 the status or outcome of an investigation. 1-37 (c) The commission shall require each health and human 1-38 services agency that performs any aspect of the state Medicaid 1-39 program to participate in the implementation and use of the 1-40 automated fraud investigation tracking system. 1-41 Sec. 531.1062. RECOVERY MONITORING SYSTEM. (a) The 1-42 commission shall use an automated recovery monitoring system to 1-43 monitor the collections process for a settled case of fraud, 1-44 abuse, or insufficient quality of care under the state Medicaid 1-45 program. 1-46 (b) The recovery monitoring system must: 1-47 (1) monitor the collection of funds resulting from 1-48 settled cases, including: 1-49 (A) recording monetary payments received from a 1-50 provider who has agreed to a monetary payment plan; and 1-51 (B) recording deductions taken through the 1-52 recoupment program from subsequent Medicaid claims filed by the 1-53 provider; and 1-54 (2) provide immediate notice of a provider who has 1-55 agreed to a monetary payment plan or to deductions through the 1-56 recoupment program from subsequent Medicaid claims who fails to 1-57 comply with the settlement agreement, including providing notice of 1-58 a provider who does not make a scheduled payment or who pays less 1-59 than the scheduled amount. 1-60 SECTION 2. Section 22.0252, Human Resources Code, is amended 1-61 by adding Subsections (c) and (d) to read as follows: 1-62 (c) The department shall ensure that the telephone 1-63 collection program attempts to collect reimbursement for all 1-64 identified delinquent payments for which 15 days or more have 2-1 elapsed since the initial notice of delinquency was sent to the 2-2 recipient. 2-3 (d) The department shall use an automated collections system 2-4 to monitor the results of the telephone collection program. The 2-5 system must: 2-6 (1) accept data from the accounts receivable tracking 2-7 system used by the department; 2-8 (2) automate recording tasks performed by a collector, 2-9 including providing access to department records regarding the 2-10 recipient and recording notes and actions resulting from a call 2-11 placed to the recipient; 2-12 (3) automatically generate a letter to a recipient 2-13 following a telephone contact that confirms the action to be taken 2-14 regarding the delinquency; 2-15 (4) monitor the receipt of scheduled payments from a 2-16 recipient for repayment of a delinquency; and 2-17 (5) generate reports regarding the effectiveness of 2-18 individual collectors and of the telephone collection program. 2-19 SECTION 3. Not later than January 1, 2000, the Health and 2-20 Human Services Commission shall: 2-21 (1) implement the automated fraud investigation 2-22 tracking system required by Section 531.1061, Government Code, as 2-23 added by by this Act; and 2-24 (2) award the contract for the purchase and 2-25 installation of commercially available accounting software 2-26 necessary to implement the recovery monitoring system required by 2-27 Section 531.1062, Government Code, as added by this Act, and begin 2-28 using the software. 2-29 SECTION 4. Not later than August 1, 2000, the Texas 2-30 Department of Human Services shall implement the automated 2-31 collections system required by Section 22.0252, Human Resources 2-32 Code, as amended by this Act. 2-33 SECTION 5. This Act takes effect September 1, 1999. 2-34 SECTION 6. The importance of this legislation and the 2-35 crowded condition of the calendars in both houses create an 2-36 emergency and an imperative public necessity that the 2-37 constitutional rule requiring bills to be read on three several 2-38 days in each house be suspended, and this rule is hereby suspended. 2-39 * * * * *