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. _______________________________ _______________________________ President of the Senate Speaker of the House I hereby certify that S.B. No. 11 passed the Senate on March 11, 1999, by the following vote: Yeas 31, Nays 0. _______________________________ Secretary of the Senate I hereby certify that S.B. No. 11 passed the House on April 16, 1999, by a non-record vote. _______________________________ Chief Clerk of the House Approved: _______________________________ Date _______________________________ Governor