1-1 By: Zaffirini, Carona S.B. No. 11 1-2 (In the Senate - Filed November 9, 1998; January 26, 1999, 1-3 read first time and referred to Committee on Human Services; 1-4 March 4, 1999, reported adversely, with favorable Committee 1-5 Substitute by the following vote: Yeas 5, Nays 0; March 4, 1999, 1-6 sent to printer.) 1-7 COMMITTEE SUBSTITUTE FOR S.B. No. 11 By: Zaffirini 1-8 A BILL TO BE ENTITLED 1-9 AN ACT 1-10 relating to the mental state applicable to certain violations under 1-11 the state Medicaid program. 1-12 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-13 SECTION 1. Subsection (a), Section 32.039, Human Resources 1-14 Code, is amended by adding Subdivision (4) to read as follows: 1-15 (4) A person "should know" or "should have known" 1-16 information to be false if the person acts in deliberate ignorance 1-17 of the truth or falsity of the information or in reckless disregard 1-18 of the truth or falsity of the information, and proof of the 1-19 person's specific intent to defraud is not required. 1-20 SECTION 2. Subsections (b) and (d), Section 32.039, Human 1-21 Resources Code, are amended to read as follows: 1-22 (b) A person commits a violation if the person: 1-23 (1) presents or causes to be presented to the 1-24 department a claim that contains a statement or representation the 1-25 person knows or should know to be false; or 1-26 (2) is a managed care organization that contracts with 1-27 the department to provide or arrange to provide health care 1-28 benefits or services to individuals eligible for medical assistance 1-29 and: 1-30 (A) fails to provide to an individual a health 1-31 care benefit or service that the organization is required to 1-32 provide under the contract with the department; 1-33 (B) fails to provide to the department 1-34 information required to be provided by law, department rule, or 1-35 contractual provision; 1-36 (C) engages in a fraudulent activity in 1-37 connection with the enrollment in the organization's managed care 1-38 plan of an individual eligible for medical assistance or in 1-39 connection with marketing the organization's services to an 1-40 individual eligible for medical assistance; or 1-41 (D) engages in actions that indicate a pattern 1-42 of: 1-43 (i) wrongful denial of payment for a 1-44 health care benefit or service that the organization is required to 1-45 provide under the contract with the department; or 1-46 (ii) wrongful delay of at least 45 days or 1-47 a longer period specified in the contract with the department, not 1-48 to exceed 60 days, in making payment for a health care benefit or 1-49 service that the organization is required to provide under the 1-50 contract with the department. 1-51 (d) Unless the provider submitted information to the 1-52 department for use in preparing a voucher that the provider knew or 1-53 should have known was false or failed to correct information that 1-54 the provider knew or should have known was false when provided an 1-55 opportunity to do so, this section does not apply to a claim based 1-56 on the voucher if the department calculated and printed the amount 1-57 of the claim on the voucher and then submitted the voucher to the 1-58 provider for the provider's signature. In addition, the provider's 1-59 signature on the voucher does not constitute fraud. The department 1-60 shall adopt rules that establish a grace period during which errors 1-61 contained in a voucher prepared by the department may be corrected 1-62 without penalty to the provider. 1-63 SECTION 3. The change in law made by Section 2 of this Act 1-64 applies only to a violation committed on or after the effective 2-1 date of this Act. For purposes of this section, a violation is 2-2 committed on or after the effective date of this Act only if each 2-3 element of the violation occurs on or after that date. A violation 2-4 committed before the effective date of this Act is covered by the 2-5 law in effect when the violation was committed, and the former law 2-6 is continued in effect for that purpose. 2-7 SECTION 4. This Act takes effect September 1, 1999. 2-8 SECTION 5. The importance of this legislation and the 2-9 crowded condition of the calendars in both houses create an 2-10 emergency and an imperative public necessity that the 2-11 constitutional rule requiring bills to be read on three several 2-12 days in each house be suspended, and this rule is hereby suspended. 2-13 * * * * *