H0059B2224A03061 DMS:BTW 07/25/17 #90 A03061
AMENDMENTS TO HOUSE BILL NO. 59
Sponsor: SENATOR CORMAN
Printer's No. 2224
Amend Bill, page 1, lines 10 and 11, by striking out "FURTHER
PROVIDING FOR PERSONS ELIGIBLE FOR MEDICAL ASSISTANCE,
PROVIDING"
Amend Bill, page 1, line 15, by striking out "AND" and
inserting a comma
Amend Bill, page 1, lines 16 through 18, by striking out ",
FURTHER PROVIDING FOR MEDICAL ASSISTANCE BENEFIT" in line 16,
all of line 17 and "PROVIDING" in line 18 and inserting
and
Amend Bill, page 1, lines 22 through 24, by striking out "IN
NURSING FACILITY ASSESSMENTS, FURTHER" in line 22, all of line
23 and "RELATING TO CALCULATION;" in line 24
Amend Bill, page 4, lines 8 through 30; page 5, lines 1
through 22; by striking out all of said lines on said pages and
inserting
(a) The department shall evaluate the efficacy and cost
effectiveness of software programs designed to identify and
prevent fraudulent, incorrect and duplicative payments within
medical assistance, Temporary Assistance to Needy Families and
the Supplemental Nutrition Assistance Program. The following
apply:
(1) No later than September 30, 2017, the department shall
publish a request for information regarding the use of software
programs under this subsection and requesting prospective
participants in an efficiency evaluation. The request for
information shall include the requirement that the savings to
the Commonwealth from the use of the software program exceed the
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cost of implementing and maintaining the software program. The
request for information shall be an informal document and may
not be construed to be a request for proposal or an invitation
to bid.
(2) (i) Subject to subclause (ii), no later than December
31, 2017, the department shall select no fewer than three
prospective participants that have responded to the request for
information under clause (1) to participate voluntarily in an
efficiency evaluation. The department shall provide participants
selected under this subclause with a test data set of claim,
payment and other information relating to medical assistance,
Temporary Assistance to Needy Families and the Supplemental
Nutrition Assistance Program. The department may require the
participant to agree to any relevant confidentiality
requirements or redact or otherwise anonymize the information as
necessary to comply with law.
(ii) The department may not be required to conduct the
efficiency evaluation if the responses to the request for
information under clause (1) do not demonstrate that the savings
to the Commonwealth from the use of the software program exceed
the cost of implementing and maintaining the software program.
(3) No later than February 15, 2018, the participants
selected under clause (2)(i) shall provide to the department a
report identifying potentially fraudulent, incorrect and
duplicative payments within the data set. A participant may make
a recommendation to the department on ways that the department
could have avoided making the payment and any methods available
for recovering money relating to the payment.
(b) No later than March 15, 2018, the department shall issue
a report with respect to the information obtained from the
participants' performance in the efficiency evaluation and any
related recommendations. The report may include a comparison of
the performance of the department's programs to identify and
prevent fraudulent, incorrect and duplicative payments on the
same data set. The report shall not include transaction-level
data and may not include any identifying information relating to
the payments. The report shall be issued to the chairperson and
the minority chairperson of the Appropriations Committee of the
Senate, the chairperson and minority chairperson of the Health
and Human Services Committee of the Senate, the chairperson and
minority chairperson of the Appropriations Committee of the
House of Representatives and the chairperson and minority
chairperson of the Health Committee of the House of
Representatives.
Amend Bill, page 7, line 30; page 8, lines 1 through 30; page
9, lines 1 through 13; by striking out all of said lines on said
pages
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Amend Bill, page 10, lines 15 through 20, by striking out
"BEFORE" in line 15 and all of lines 16 through 20 and inserting
(a) Before submitting to the General Assembly a supplemental
appropriation request for the medical assistance capitation and
fee-for-service General Fund appropriations for fiscal year
2017-2018, the department shall either request a waiver or
submit a State plan amendment from the appropriate Federal
agency for approval. The waiver request or the State plan
amendment shall request additional Federal financial
participation, reduce expenditures for the medical assistance
program or provide program efficiencies.
(b) If the department submits a waiver request or State plan
amendment meeting the requirements of subsection (a) after the
effective date of this section, the department is not required
to submit an additional waiver request or a State plan amendment
prior to submitting a supplemental appropriation request.
(c) The department is not required to submit a waiver
request or a State plan amendment under this section if there is
a reduction in Federal funding during the State fiscal year
2017-2018.
Amend Bill, page 10, line 25, by striking out "AND" and
inserting
or
Amend Bill, page 10, line 26, by striking out "THOSE
PHYSICALLY OR MENTALLY ABLE" and inserting
nondisabled, nonpregnant, nonelderly Medicaid eligible
adults
Amend Bill, page 10, line 27, by inserting a period after
"BENEFITS"
Amend Bill, page 10, lines 27 through 30; page 11, lines 1
through 14; by striking out ", SUCH AS" in line 27, all of lines
28 through 30 on page 10 and all of lines 1 through 14 on page
11
Amend Bill, page 14, line 4, by striking out "6" and
inserting
2
Amend Bill, page 14, line 15, by striking out "7" and
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inserting
3
Amend Bill, page 14, lines 25 through 30; page 15, lines 1
through 19; by striking out all of said lines on said pages
Amend Bill, page 15, line 20, by striking out "10" and
inserting
4
Amend Bill, page 16, line 13, by striking out "11" and
inserting
5
Amend Bill, page 16, line 19, by striking out "12" and
inserting
6
Amend Bill, page 17, line 16, by striking out "13" and
inserting
7
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See A03061 in
the context
of HB0059