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.