HLS 161ES-190 ORIGINAL
2016 First Extraordinary Session
HOUSE BILL NO. 89
BY REPRESENTATIVE STOKES
FUNDS/FUNDING: Provides relative to allocation and uses of monies dedicated to the
Medical Assistance Programs Fraud Detection Fund (Item #7)
1 AN ACT
2To amend and reenact R.S. 46:440.1(C) through (E) and to enact R.S. 46:440.1(F), relative
3 to the Medical Assistance Programs Fraud Detection Fund; to provide for allocation
4 of monies in the fund; to allocate fund monies among the attorney general, the
5 Department of Health and Hospitals, and the legislative auditor; to authorize certain
6 uses of fund monies; and to provide for related matters.
7Be it enacted by the Legislature of Louisiana:
8 Section 1. R.S. 46:440.1(C) through (E) are hereby amended and reenacted and R.S.
946:440.1(F) is hereby enacted to read as follows:
10 ยง440.1. Medical Assistance Programs Fraud Detection Fund
11 * * *
12 C. Fifty Forty-five percent of the monies collected and deposited into the
13 fund shall be allocated to the Medicaid Fraud Control Unit within the office of the
14 attorney general.
15 D. Fifty Forty-five percent of the monies collected and deposited into the
16 fund shall be allocated to the Department of Health and Hospitals to be used solely
17 for Medicaid fraud detection and for the purposes specified in Subsection E
18 Subsection F of this Section.
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CODING: Words in struck through type are deletions from existing law; words underscored
are additions. HLS 161ES-190 ORIGINAL
HB NO. 89
1 E. Ten percent of the monies collected and deposited into the fund shall be
2 allocated to the legislative auditor to be used solely for Medicaid fraud detection and
3 for the purposes specified in Subsection F of this Section.
4 E. F. The monies in the fund shall not be used to replace, displace, or
5 supplant state general funds appropriated for the daily operation of the department
6 or the medical assistance programs and may be appropriated by the legislature for
7 the following purposes only:
8 (1) To pay costs or expenses incurred by the department or the attorney
9 general relative to an action instituted pursuant to this Part.
10 (2) To enhance fraud and abuse detection and prevention activities related
11 to the medical assistance programs.
12 (3) To pay rewards for information concerning fraud and abuse as provided
13 in Subpart B of this Part.
14 (4) To perform any of the following functions with respect to Medicaid
15 managed care organizations as defined in Part XIII of this Chapter:
16 (a) Validation of claims data received by managed care organizations.
17 (b) Analysis of claim integrity units of managed care organizations.
18 (c) Review of actuarial assumptions and methods.
19 (4) (5) To provide a source of revenue for the Medical Assistance Program
20 in the event of a change in federal policy which results in an increase in state
21 participation or a shortfall in state general fund due to a decrease in the official
22 forecast, as defined in R.S. 39:2(30), during a fiscal year.
23 Section 2. This Act shall become effective upon signature by the governor or, if not
24signed by the governor, upon expiration of the time for bills to become law without signature
25by the governor, as provided by Article III, Section 18 of the Constitution of Louisiana. If
26vetoed by the governor and subsequently approved by the legislature, this Act shall become
27effective on the day following such approval.
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CODING: Words in struck through type are deletions from existing law; words underscored
are additions. HLS 161ES-190 ORIGINAL
HB NO. 89
DIGEST
The digest printed below was prepared by House Legislative Services. It constitutes no part
of the legislative instrument. The keyword, one-liner, abstract, and digest do not constitute
part of the law or proof or indicia of legislative intent. [R.S. 1:13(B) and 24:177(E)]
HB 89 Original 2016 First Extraordinary Session Stokes
Abstract: Provides relative to uses of monies dedicated to the Medical Assistance
Programs Fraud Detection Fund and for allocation of fund monies among the
attorney general, the Dept. of Health and Hospitals (DHH), and the legislative
auditor.
Present law establishes the Medical Assistance Programs Fraud Detection Fund and
authorizes purposes for which monies in the fund may be used. Proposed law retains present
law.
Present law provides for the following allocation of monies in the fund:
(1)50% shall be allocated to the Medicaid Fraud Control Unit within the office of the
attorney general.
(2)50% shall be allocated to DHH to be used solely for Medicaid fraud detection and
for purposes specified in present law.
Proposed law revises present law to add the legislative auditor as an entity which may utilize
monies in the fund, and to provide for the following allocation of such monies:
(1)45% shall be allocated to the Medicaid Fraud Control Unit within the office of the
attorney general.
(2)45% shall be allocated to DHH to be used solely for Medicaid fraud detection and
for purposes specified in present law and proposed law.
(3)10% shall be allocated to the legislative auditor to be used solely for Medicaid fraud
detection and for purposes specified in present law and proposed law.
Present law provides that the monies in the fund shall not be used to replace, displace, or
supplant state general funds appropriated for the daily operation of DHH or the Medicaid
program, and may be appropriated by the legislature only for certain enumerated purposes.
Proposed law retains present law, and adds performance of any of the following functions
with respect to Medicaid managed care organizations as authorized uses of fund monies:
(1)Validation of claims data received by managed care organizations.
(2)Analysis of claim integrity units of managed care organizations.
(3)Review of actuarial assumptions and methods.
Effective upon signature of governor or lapse of time for gubernatorial action.
(Amends R.S. 46:440.1(C)-(E); Adds R.S. 46:440.1(F))
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CODING: Words in struck through type are deletions from existing law; words underscored
are additions.