By: Zaffirini, Carona S.B. No. 11
A BILL TO BE ENTITLED
AN ACT
1-1 relating to the mental state applicable to certain violations under
1-2 the state Medicaid program.
1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-4 SECTION 1. Subsection (a), Section 32.039, Human Resources
1-5 Code, is amended by adding Subdivision (4) to read as follows:
1-6 (4) A person "should know" or "should have known"
1-7 information to be false if the person acts in deliberate ignorance
1-8 of the truth or falsity of the information or in reckless disregard
1-9 of the truth or falsity of the information, and proof of the
1-10 person's specific intent to defraud is not required.
1-11 SECTION 2. Subsections (b) and (d), Section 32.039, Human
1-12 Resources Code, are amended to read as follows:
1-13 (b) A person commits a violation if the person:
1-14 (1) presents or causes to be presented to the
1-15 department a claim that contains a statement or representation the
1-16 person knows or should know to be false; or
1-17 (2) is a managed care organization that contracts with
1-18 the department to provide or arrange to provide health care
1-19 benefits or services to individuals eligible for medical assistance
1-20 and:
1-21 (A) fails to provide to an individual a health
1-22 care benefit or service that the organization is required to
1-23 provide under the contract with the department;
1-24 (B) fails to provide to the department
2-1 information required to be provided by law, department rule, or
2-2 contractual provision;
2-3 (C) engages in a fraudulent activity in
2-4 connection with the enrollment in the organization's managed care
2-5 plan of an individual eligible for medical assistance or in
2-6 connection with marketing the organization's services to an
2-7 individual eligible for medical assistance; or
2-8 (D) engages in actions that indicate a pattern
2-9 of:
2-10 (i) wrongful denial of payment for a
2-11 health care benefit or service that the organization is required to
2-12 provide under the contract with the department; or
2-13 (ii) wrongful delay of at least 45 days or
2-14 a longer period specified in the contract with the department, not
2-15 to exceed 60 days, in making payment for a health care benefit or
2-16 service that the organization is required to provide under the
2-17 contract with the department.
2-18 (d) Unless the provider submitted information to the
2-19 department for use in preparing a voucher that the provider knew or
2-20 should have known was false or failed to correct information that
2-21 the provider knew or should have known was false when provided an
2-22 opportunity to do so, this section does not apply to a claim based
2-23 on the voucher if the department calculated and printed the amount
2-24 of the claim on the voucher and then submitted the voucher to the
2-25 provider for the provider's signature. In addition, the provider's
2-26 signature on the voucher does not constitute fraud. The department
3-1 shall adopt rules that establish a grace period during which errors
3-2 contained in a voucher prepared by the department may be corrected
3-3 without penalty to the provider.
3-4 SECTION 3. The change in law made by Section 2 of this Act
3-5 applies only to a violation committed on or after the effective
3-6 date of this Act. For purposes of this section, a violation is
3-7 committed on or after the effective date of this Act only if each
3-8 element of the violation occurs on or after that date. A violation
3-9 committed before the effective date of this Act is covered by the
3-10 law in effect when the violation was committed, and the former law
3-11 is continued in effect for that purpose.
3-12 SECTION 4. This Act takes effect September 1, 1999.
3-13 SECTION 5. The importance of this legislation and the
3-14 crowded condition of the calendars in both houses create an
3-15 emergency and an imperative public necessity that the
3-16 constitutional rule requiring bills to be read on three several
3-17 days in each house be suspended, and this rule is hereby suspended.