Texas 2017 - 85th Regular

Texas House Bill HB2969 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New	Differences
1	1	85R23202 MM-D
2	2	By: Raymond H.B. No. 2969
3	3	Substitute the following for H.B. No. 2969:
4	4	By: Keough C.S.H.B. No. 2969
5	5
6	6
7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to fraud, waste, and abuse in Medicaid and other health and
10	10	human services programs.
11	11	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	12	SECTION 1. Sections 531.102(j) and (k), Government Code,
13	13	are amended to read as follows:
14	14	(j) The office shall prepare a final report on each audit,
15	15	inspection, or investigation conducted under this section. The
16	16	final report must include:
17	17	(1) a summary of the activities performed by the
18	18	office in conducting the audit, inspection, or investigation;
19	19	(2) a statement regarding whether the audit,
20	20	inspection, or investigation resulted in a finding of any
21	21	wrongdoing; and
22	22	(3) a description of any findings of wrongdoing.
23	23	(k) A final report on an audit, inspection, or investigation
24	24	is subject to required disclosure under Chapter 552. All
25	25	information and materials compiled during the audit, inspection, or
26	26	investigation remain confidential and not subject to required
27	27	disclosure in accordance with Section 531.1021(g). A confidential
28	28	draft report on an audit, inspection, or investigation that
29	29	concerns the death of a child may be shared with the Department of
30	30	Family and Protective Services. A draft report that is shared with
31	31	the Department of Family and Protective Services remains
32	32	confidential and is not subject to disclosure under Chapter 552.
33	33	SECTION 2. Section 531.1021(g), Government Code, is amended
34	34	to read as follows:
35	35	(g) All information and materials subpoenaed or compiled by
36	36	the office in connection with an audit, inspection, or
37	37	investigation or by the office of the attorney general in
38	38	connection with a Medicaid fraud investigation are confidential and
39	39	not subject to disclosure under Chapter 552, and not subject to
40	40	disclosure, discovery, subpoena, or other means of legal compulsion
41	41	for their release to anyone other than the office or the attorney
42	42	general or their employees or agents involved in the audit,
43	43	inspection, or investigation conducted by the office or the
44	44	attorney general, except that this information may be disclosed to
45	45	the state auditor's office, law enforcement agencies, and other
46	46	entities as permitted by other law.
47	47	SECTION 3. The heading to Section 531.106, Government Code,
48	48	is amended to read as follows:
49	49	Sec. 531.106. LEARNING, [OR] NEURAL NETWORK, OR OTHER
50	50	TECHNOLOGY.
51	51	SECTION 4. Sections 531.106(a), (c), and (g), Government
52	52	Code, are amended to read as follows:
53	53	(a) The commission shall use learning, [or] neural network,
54	54	or other technology to identify and deter fraud in Medicaid
55	55	throughout this state.
56	56	(c) The data used for data [neural network] processing shall
57	57	be maintained as an independent subset for security purposes.
58	58	(g) Each month, the [learning or neural network] technology
59	59	implemented under this section must match vital statistics unit
60	60	death records with Medicaid claims filed by a provider. If the
61	61	commission determines that a provider has filed a claim for
62	62	services provided to a person after the person's date of death, as
63	63	determined by the vital statistics unit death records, the
64	64	commission shall refer the case for investigation to the
65	65	commission's office of inspector general.
66	66	SECTION 5. Section 531.1061(b), Government Code, is amended
67	67	to read as follows:
68	68	(b) For each case of suspected fraud, abuse, or insufficient
69	69	quality of care identified by the [learning or neural network]
70	70	technology required under Section 531.106, the automated fraud
71	71	investigation tracking system must:
72	72	(1) receive electronically transferred records
73	73	relating to the identified case from the [learning or neural
74	74	network] technology;
75	75	(2) record the details and monitor the status of an
76	76	investigation of the identified case, including maintaining a
77	77	record of the beginning and completion dates for each phase of the
78	78	case investigation;
79	79	(3) generate documents and reports related to the
80	80	status of the case investigation; and
81	81	(4) generate standard letters to a provider regarding
82	82	the status or outcome of an investigation.
83	83	SECTION 6. Section 531.1131, Government Code, is amended by
84	84	amending Subsections (a), (b), and (c) and adding Subsections
85	85	(c-1), (c-2), and (c-3) to read as follows:
86	86	(a) If a managed care organization [organization's special
87	87	investigative unit under Section 531.113(a)(1)] or an [the] entity
88	88	with which the managed care organization contracts under Section
89	89	531.113(a)(2) discovers fraud or abuse in Medicaid or the child
90	90	health plan program, the organization [unit] or entity shall:
91	91	(1) immediately submit written notice to [and
92	92	contemporaneously notify] the commission's office of inspector
93	93	general and the office of the attorney general in the form and
94	94	manner prescribed by the office of inspector general and containing
95	95	a detailed description of the fraud or abuse and each payment made
96	96	to a provider as a result of the fraud or abuse;
97	97	(2) subject to Subsection (b), begin payment recovery
98	98	efforts; and
99	99	(3) ensure that any payment recovery efforts in which
100	100	the organization engages are in accordance with applicable rules
101	101	adopted by the executive commissioner.
102	102	(b) If the amount sought to be recovered under Subsection
103	103	(a)(2) exceeds $100,000, the managed care organization
104	104	[organization's special investigative unit] or the contracted
105	105	entity described by Subsection (a) may not engage in payment
106	106	recovery efforts if, not later than the 10th business day after the
107	107	date the organization [unit] or entity notified the commission's
108	108	office of inspector general and the office of the attorney general
109	109	under Subsection (a)(1), the organization [unit] or entity receives
110	110	a notice from either office indicating that the organization [unit]
111	111	or entity is not authorized to proceed with recovery efforts.
112	112	(c) A managed care organization may retain one-half of any
113	113	money recovered under Subsection (a)(2) by the organization
114	114	[organization's special investigative unit] or the contracted
115	115	entity described by Subsection (a). The managed care organization
116	116	shall remit the remaining amount of money recovered under
117	117	Subsection (a)(2) to the commission's office of inspector general.
118	118	(c-1) If the commission's office of inspector general
119	119	notifies a managed care organization under Subsection (b), proceeds
120	120	with recovery efforts, and recovers all or part of the payments the
121	121	organization identified as required by Subsection (a)(1), the
122	122	organization is entitled to one-half of the amount recovered for
123	123	each payment the organization identified after any applicable
124	124	federal share is deducted. The managed care organization may not
125	125	receive more than one-half of the total amount of money recovered
126	126	after any applicable federal share is deducted.
127	127	(c-2) Notwithstanding any provision of this section, if the
128	128	commission's office of inspector general discovers fraud, waste, or
129	129	abuse in Medicaid or the child health plan program in the
130	130	performance of its duties, the office may recover payments made to a
131	131	provider as a result of the fraud, waste, or abuse as otherwise
132	132	provided by this subchapter.
133	133	(c-3) With respect to fraud or abuse alleged in any notice
134	134	received under Subsection (a), the commission's office of inspector
135	135	general shall coordinate with appropriate managed care
136	136	organizations to ensure that the office and an organization or an
137	137	entity with which an organization contracts under Section
138	138	531.113(a)(2) do not both simultaneously pursue recovery efforts
139	139	under this section for the same case of fraud, waste, or abuse.
140	140	SECTION 7. Section 531.1131, Government Code, as amended by
141	141	this Act, applies only to an amount of money recovered on or after
142	142	the effective date of this Act. An amount of money recovered before
143	143	the effective date of this Act is governed by the law in effect
144	144	immediately before that date, and that law is continued in effect
145	145	for that purpose.
146	146	SECTION 8. If before implementing any provision of this Act
147	147	a state agency determines that a waiver or authorization from a
148	148	federal agency is necessary for implementation of that provision,
149	149	the agency affected by the provision shall request the waiver or
150	150	authorization and may delay implementing that provision until the
151	151	waiver or authorization is granted.
152	152	SECTION 9. This Act takes effect immediately if it receives
153	153	a vote of two-thirds of all the members elected to each house, as
154	154	provided by Section 39, Article III, Texas Constitution. If this
155	155	Act does not receive the vote necessary for immediate effect, this
156	156	Act takes effect September 1, 2017.