By Zaffirini, et al. S.B. No. 11 76R1913 KKA-D A BILL TO BE ENTITLED 1-1 AN ACT 1-2 relating to the mental state applicable to certain violations under 1-3 the state Medicaid program. 1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-5 SECTION 1. Sections 32.039(b) and (d), Human Resources Code, 1-6 are amended to read as follows: 1-7 (b) A person commits a violation if the person: 1-8 (1) presents or causes to be presented to the 1-9 department a claim that contains a statement or representation the 1-10 person knows or should know to be false; or 1-11 (2) is a managed care organization that contracts with 1-12 the department to provide or arrange to provide health care 1-13 benefits or services to individuals eligible for medical assistance 1-14 and: 1-15 (A) fails to provide to an individual a health 1-16 care benefit or service that the organization is required to 1-17 provide under the contract with the department; 1-18 (B) fails to provide to the department 1-19 information required to be provided by law, department rule, or 1-20 contractual provision; 1-21 (C) engages in a fraudulent activity in 1-22 connection with the enrollment in the organization's managed care 1-23 plan of an individual eligible for medical assistance or in 1-24 connection with marketing the organization's services to an 2-1 individual eligible for medical assistance; or 2-2 (D) engages in actions that indicate a pattern 2-3 of: 2-4 (i) wrongful denial of payment for a 2-5 health care benefit or service that the organization is required to 2-6 provide under the contract with the department; or 2-7 (ii) wrongful delay of at least 45 days or 2-8 a longer period specified in the contract with the department, not 2-9 to exceed 60 days, in making payment for a health care benefit or 2-10 service that the organization is required to provide under the 2-11 contract with the department. 2-12 (d) Unless the provider submitted information to the 2-13 department for use in preparing a voucher that the provider knew or 2-14 should have known was false or failed to correct information that 2-15 the provider knew or should have known was false when provided an 2-16 opportunity to do so, this section does not apply to a claim based 2-17 on the voucher if the department calculated and printed the amount 2-18 of the claim on the voucher and then submitted the voucher to the 2-19 provider for the provider's signature. In addition, the provider's 2-20 signature on the voucher does not constitute fraud. The department 2-21 shall adopt rules that establish a grace period during which errors 2-22 contained in a voucher prepared by the department may be corrected 2-23 without penalty to the provider. 2-24 SECTION 2. The change in law made by Section 1 of this Act 2-25 applies only to a violation committed on or after the effective 2-26 date of this Act. For purposes of this section, a violation is 2-27 committed on or after the effective date of this Act only if each 3-1 element of the violation occurs on or after that date. A violation 3-2 committed before the effective date of this Act is covered by the 3-3 law in effect when the violation was committed, and the former law 3-4 is continued in effect for that purpose. 3-5 SECTION 3. This Act takes effect September 1, 1999. 3-6 SECTION 4. The importance of this legislation and the 3-7 crowded condition of the calendars in both houses create an 3-8 emergency and an imperative public necessity that the 3-9 constitutional rule requiring bills to be read on three several 3-10 days in each house be suspended, and this rule is hereby suspended.