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.
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