Texas 2025 - 89th Regular

Texas Senate Bill SB961 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	By: Kolkhorst, et al. S.B. No. 961
2		-
3		-
	1	+	By: Kolkhorst S.B. No. 961
	2	+	(In the Senate - Filed January 29, 2025; February 13, 2025,
	3	+	read first time and referred to Committee on Health & Human
	4	+	Services; March 24, 2025, reported adversely, with favorable
	5	+	Committee Substitute by the following vote: Yeas 7, Nays 1;
	6	+	March 24, 2025, sent to printer.)
	7	+	Click here to see the committee vote
	8	+	COMMITTEE SUBSTITUTE FOR S.B. No. 961 By: Hughes
4	9
5	10
6	11		A BILL TO BE ENTITLED
7	12		AN ACT
8	13		relating to fraud prevention and verifying eligibility for benefits
9	14		under Medicaid.
10	15		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	16		SECTION 1. Section 544.0455, Government Code, as effective
12	17		April 1, 2025, is amended by adding Subsection (g) to read as
13	18		follows:
14	19		(g) The commission may not waive or seek authorization to
15	20		waive a requirement that the commission conduct periodic electronic
16	21		data matches to verify a Medicaid recipient's income eligibility
17	22		under this section or other law.
18	23		SECTION 2. Section 544.0456, Government Code, as effective
19	24		April 1, 2025, is amended by amending Subsection (c) and adding
20	25		Subsection (c-1) to read as follows:
21	26		(c) On a monthly basis, the commission shall:
22	27		(1) conduct electronic data matches with the Texas
23	28		Lottery Commission to determine whether a recipient of supplemental
24	29		nutrition assistance benefits or Medicaid benefits or a recipient's
25	30		household member received reportable lottery winnings;
26	31		(2) use the database system developed under Section
27	32		532.0201 to:
28	33		(A) match vital statistics unit death records
29	34		with a list of individuals eligible for financial assistance
30	35		benefits, [or] supplemental nutrition assistance benefits, or
31	36		Medicaid benefits; and
32	37		(B) ensure that any individual receiving
33	38		benefits [assistance] under a [either] program described by
34	39		Paragraph (A) who is discovered to be deceased has the individual's
35	40		eligibility for benefits [assistance] promptly terminated; [and]
36	41		(3) review the out-of-state electronic benefit
37	42		transfer card transactions a recipient of supplemental nutrition
38	43		assistance benefits made to determine whether those transactions
39	44		indicate a possible change in the recipient's residence; and
40	45		(4) if a Medicaid recipient also receives supplemental
41	46		nutrition assistance benefits, review electronic benefit transfer
42	47		card transactions made exclusively out of state by the recipient to
43	48		determine whether the transactions indicate a possible change in
44	49		the recipient's residence for purposes of Medicaid eligibility.
45	50		(c-1) On at least a quarterly basis, the commission shall
46	51		determine whether a Medicaid recipient's voter registration has
47	52		been canceled under Subchapter B, Chapter 16, Election Code, or for
48	53		any other reason during the preceding 36-month period, to determine
49	54		whether the cancellation indicates a possible change in the
50	55		recipient's eligibility for Medicaid benefits.
51	56		SECTION 3. Subchapter B, Chapter 32, Human Resources Code,
52	57		is amended by adding Section 32.0267 to read as follows:
53	58		Sec. 32.0267. VERIFICATION OF CERTAIN SELF-ATTESTED
54	59		ELIGIBILITY CRITERIA. Except as provided by Section
55	60		32.024715(b)(3)(B) and unless self-attestation is permitted by
56	61		federal law, when determining and certifying a person's eligibility
57	62		for medical assistance, the commission may not accept
58	63		self-attestation of the person's income, residency, citizenship,
59	64		age, household composition, caretaker relative status, or access to
60	65		other health coverage without additional verification. The
61	66		additional verification must be obtained by or provided to the
62	67		commission before the commission may enroll or reenroll the person
63	68		in the medical assistance program. The commission must attempt to
64	69		obtain the additional verification through electronic data
65	70		matching before requesting documentation from the person.
66	71		SECTION 4. Section 36.002, Human Resources Code, is amended
67	72		to read as follows:
68	73		Sec. 36.002. UNLAWFUL ACTS. A person commits an unlawful
69	74		act if the person:
70	75		(1) knowingly makes or causes to be made a false
71	76		statement or misrepresentation of a material fact to permit a
72	77		person to receive a benefit or payment under a health care program
73	78		that is not authorized or that is greater than the benefit or
74	79		payment that is authorized;
75	80		(2) knowingly conceals or fails to disclose
76	81		information that permits a person to receive a benefit or payment
77	82		under a health care program that is not authorized or that is
78	83		greater than the benefit or payment that is authorized;
79	84		(3) knowingly applies for and receives a benefit or
80	85		payment on behalf of another person under a health care program and
81	86		converts any part of the benefit or payment to a use other than for
82	87		the benefit of the person on whose behalf it was received;
83	88		(4) knowingly makes, causes to be made, induces, or
84	89		seeks to induce the making of a false statement or
85	90		misrepresentation of material fact concerning:
86	91		(A) the conditions or operation of a facility in
87	92		order that the facility may qualify for certification or
88	93		recertification required by a health care program, including
89	94		certification or recertification as:
90	95		(i) a hospital;
91	96		(ii) a nursing facility or skilled nursing
92	97		facility;
93	98		(iii) a hospice;
94	99		(iv) an ICF-IID;
95	100		(v) an assisted living facility; or
96	101		(vi) a home health agency; or
97	102		(B) information required to be provided by a
98	103		federal or state law, rule, regulation, or provider agreement
99	104		pertaining to a health care program;
100	105		(5) except as authorized under a health care program,
101	106		knowingly pays, charges, solicits, accepts, or receives, in
102	107		addition to an amount paid under the program, a gift, money, a
103	108		donation, or other consideration as a condition to the provision of
104	109		a service or product or the continued provision of a service or
105	110		product if the cost of the service or product is paid for, in whole
106	111		or in part, under the program;
107	112		(6) knowingly presents or causes to be presented a
108	113		claim for payment under a health care program for a product provided
109	114		or a service rendered by a person who:
110	115		(A) is not licensed to provide the product or
111	116		render the service, if a license is required; or
112	117		(B) is not licensed in the manner claimed;
113	118		(7) knowingly makes or causes to be made a claim under
114	119		a health care program for:
115	120		(A) a service or product that has not been
116	121		approved or acquiesced in by a treating physician or health care
117	122		practitioner;
118	123		(B) a service or product that is substantially
119	124		inadequate or inappropriate when compared to generally recognized
120	125		standards within the particular discipline or within the health
121	126		care industry; or
122	127		(C) a product that has been adulterated, debased,
123	128		mislabeled, or that is otherwise inappropriate;
124	129		(8) makes a claim under a health care program and
125	130		knowingly fails to indicate:
126	131		(A) the type of license held by the licensed
127	132		health care provider who actually provided the service; or
128	133		(B) [and] the identification number of the
129	134		licensed health care provider who actually provided the service;
130	135		(9) conspires to commit a violation of Subdivision
131	136		(1), (2), (3), (4), (5), (6), (7), (8), (10), (11), (12), or (13);
132	137		(10) is a managed care organization that contracts
133	138		with the commission or other state agency to provide or arrange to
134	139		provide health care benefits or services to individuals eligible
135	140		under a health care program and knowingly:
136	141		(A) fails to provide to an individual a health
137	142		care benefit or service that the organization is required to
138	143		provide under the contract;
139	144		(B) fails to provide to the commission or
140	145		appropriate state agency information required to be provided by
141	146		law, commission or agency rule, or contractual provision; or
142	147		(C) engages in a fraudulent activity in
143	148		connection with the enrollment of an individual eligible under the
144	149		program in the organization's managed care plan or in connection
145	150		with marketing the organization's services to an individual
146	151		eligible under the program;
147	152		(11) knowingly obstructs an investigation by the
148	153		attorney general of an alleged unlawful act under this section;
149	154		(12) knowingly makes, uses, or causes the making or
150	155		use of a false record or statement material to an obligation to pay
151	156		or transmit money or property to this state under a health care
152	157		program, or knowingly conceals or knowingly and improperly avoids
153	158		or decreases an obligation to pay or transmit money or property to
154	159		this state under a health care program; or
155	160		(13) knowingly engages in conduct that constitutes a
156	161		violation under Section 32.039(b).
157	162		SECTION 5. Section 36.002, Human Resources Code, as amended
158	163		by this Act, applies only to an unlawful act committed on or after
159	164		the effective date of this Act.
160	165		SECTION 6. If before implementing any provision of this Act
161	166		a state agency determines that a waiver or authorization from a
162	167		federal agency is necessary for the implementation of that
163	168		provision, the agency affected by the provision shall request the
164	169		waiver or authorization and may delay implementing that provision
165	170		until the waiver or authorization is granted.
166	171		SECTION 7. This Act takes effect September 1, 2025.
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