85R23202 MM-D     By: Raymond H.B. No. 2969     Substitute the following for H.B. No. 2969:     By:  Keough C.S.H.B. No. 2969       A BILL TO BE ENTITLED   AN ACT   relating to fraud, waste, and abuse in Medicaid and other health and   human services programs.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Sections 531.102(j) and (k), Government Code,   are amended to read as follows:          (j)  The office shall prepare a final report on each audit,   inspection, or investigation conducted under this section.  The   final report must include:                (1)  a summary of the activities performed by the   office in conducting the audit, inspection, or investigation;                (2)  a statement regarding whether the audit,   inspection, or investigation resulted in a finding of any   wrongdoing; and                (3)  a description of any findings of wrongdoing.          (k)  A final report on an audit, inspection, or investigation   is subject to required disclosure under Chapter 552.  All   information and materials compiled during the audit, inspection, or   investigation remain confidential and not subject to required   disclosure in accordance with Section 531.1021(g).  A confidential   draft report on an audit, inspection, or investigation that   concerns the death of a child may be shared with the Department of   Family and Protective Services.  A draft report that is shared with   the Department of Family and Protective Services remains   confidential and is not subject to disclosure under Chapter 552.          SECTION 2.  Section 531.1021(g), Government Code, is amended   to read as follows:          (g)  All information and materials subpoenaed or compiled by   the office in connection with an audit, inspection, or   investigation or by the office of the attorney general in   connection with a Medicaid fraud investigation are confidential and   not subject to disclosure under Chapter 552, and not subject to   disclosure, discovery, subpoena, or other means of legal compulsion   for their release to anyone other than the office or the attorney   general or their employees or agents involved in the audit,   inspection, or investigation conducted by the office or the   attorney general, except that this information may be disclosed to   the state auditor's office, law enforcement agencies, and other   entities as permitted by other law.          SECTION 3.  The heading to Section 531.106, Government Code,   is amended to read as follows:          Sec. 531.106.  LEARNING, [OR] NEURAL NETWORK, OR OTHER   TECHNOLOGY.          SECTION 4.  Sections 531.106(a), (c), and (g), Government   Code, are amended to read as follows:          (a)  The commission shall use learning, [or] neural network,   or other technology to identify and deter fraud in Medicaid   throughout this state.          (c)  The data used for data [neural network] processing shall   be maintained as an independent subset for security purposes.          (g)  Each month, the [learning or neural network] technology   implemented under this section must match vital statistics unit   death records with Medicaid claims filed by a provider.  If the   commission determines that a provider has filed a claim for   services provided to a person after the person's date of death, as   determined by the vital statistics unit death records, the   commission shall refer the case for investigation to the   commission's office of inspector general.          SECTION 5.  Section 531.1061(b), Government Code, is amended   to read as follows:          (b)  For each case of suspected fraud, abuse, or insufficient   quality of care identified by the [learning or neural network]   technology required under Section 531.106, the automated fraud   investigation tracking system must:                (1)  receive electronically transferred records   relating to the identified case from the [learning or neural   network] technology;                (2)  record the details and monitor the status of an   investigation of the identified case, including maintaining a   record of the beginning and completion dates for each phase of the   case investigation;                (3)  generate documents and reports related to the   status of the case investigation; and                (4)  generate standard letters to a provider regarding   the status or outcome of an investigation.          SECTION 6.  Section 531.1131, Government Code, is amended by   amending Subsections (a), (b), and (c) and adding Subsections   (c-1), (c-2), and (c-3) to read as follows:          (a)  If a managed care organization [organization's special   investigative unit under Section 531.113(a)(1)] or an [the] entity   with which the managed care organization contracts under Section   531.113(a)(2) discovers fraud or abuse in Medicaid or the child   health plan program, the organization [unit] or entity shall:                (1)  immediately submit written notice to [and   contemporaneously notify] the commission's office of inspector   general and the office of the attorney general in the form and   manner prescribed by the office of inspector general and containing   a detailed description of the fraud or abuse and each payment made   to a provider as a result of the fraud or abuse;                (2)  subject to Subsection (b), begin payment recovery   efforts; and                (3)  ensure that any payment recovery efforts in which   the organization engages are in accordance with applicable rules   adopted by the executive commissioner.          (b)  If the amount sought to be recovered under Subsection   (a)(2) exceeds $100,000, the managed care organization   [organization's special investigative unit] or the contracted   entity described by Subsection (a) may not engage in payment   recovery efforts if, not later than the 10th business day after the   date the organization [unit] or entity notified the commission's   office of inspector general and the office of the attorney general   under Subsection (a)(1), the organization [unit] or entity receives   a notice from either office indicating that the organization [unit]   or entity is not authorized to proceed with recovery efforts.          (c)  A managed care organization may retain one-half of any   money recovered under Subsection (a)(2) by the organization   [organization's special investigative unit] or the contracted   entity described by Subsection (a). The managed care organization   shall remit the remaining amount of money recovered under   Subsection (a)(2) to the commission's office of inspector general.          (c-1)  If the commission's office of inspector general   notifies a managed care organization under Subsection (b), proceeds   with recovery efforts, and recovers all or part of the payments the   organization identified as required by Subsection (a)(1), the   organization is entitled to one-half of the amount recovered for   each payment the organization identified after any applicable   federal share is deducted. The managed care organization may not   receive more than one-half of the total amount of money recovered   after any applicable federal share is deducted.          (c-2)  Notwithstanding any provision of this section, if the   commission's office of inspector general discovers fraud, waste, or   abuse in Medicaid or the child health plan program in the   performance of its duties, the office may recover payments made to a   provider as a result of the fraud, waste, or abuse as otherwise   provided by this subchapter.          (c-3)  With respect to fraud or abuse alleged in any notice   received under Subsection (a), the commission's office of inspector   general shall coordinate with appropriate managed care   organizations to ensure that the office and an organization or an   entity with which an organization contracts under Section   531.113(a)(2) do not both simultaneously pursue recovery efforts   under this section for the same case of fraud, waste, or abuse.          SECTION 7.  Section 531.1131, Government Code, as amended by   this Act, applies only to an amount of money recovered on or after   the effective date of this Act. An amount of money recovered before   the effective date of this Act is governed by the law in effect   immediately before that date, and that law is continued in effect   for that purpose.          SECTION 8.  If before implementing any provision of this Act   a state agency determines that a waiver or authorization from a   federal agency is necessary for implementation of that provision,   the agency affected by the provision shall request the waiver or   authorization and may delay implementing that provision until the   waiver or authorization is granted.          SECTION 9.  This Act takes effect immediately if it receives   a vote of two-thirds of all the members elected to each house, as   provided by Section 39, Article III, Texas Constitution. If this   Act does not receive the vote necessary for immediate effect, this   Act takes effect September 1, 2017.