2013 -- H 6157

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LC02683

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STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2013

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A N A C T

RELATING TO STATE AFFAIRS AND GOVERNMENT - HEALTH AND HUMAN

SERVICES

     Introduced By: Representatives Marshall, Costantino, Almeida, O'Brien, and Winfield

     Date Introduced: May 23, 2013

     Referred To: House Finance

It is enacted by the General Assembly as follows:

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     SECTION 1. Chapter 42-7.2 of the General Laws entitled "Office of Health and Human

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Services" is hereby amended by adding thereto the following section:

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     42-7.2-18. Program integrity division. -- (a) There is hereby established a program

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integrity division within the office of health and human services to effectuate the transfer of

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functions pursuant to subdivision 42-7.2-6.1(a)(7).  The purposes of this division are:

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     (1) To develop and implement a statewide strategy to coordinate state and local agencies,

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law enforcement entities, and investigative units in order to increase the effectiveness of

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programs and initiatives dealing with the prevention, detection, and prosecution of Medicaid and

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public assistance fraud; and

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     (2) To oversee and coordinate state and local efforts to investigate and eliminate

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Medicaid and public assistance fraud and to recover state and federal funds.

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     (b) The program integrity division shall provide advice and make recommendations, as

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necessary, to the secretary of health and human services and all departments assigned to the office

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to effectuate the purposes of the division.

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     (c) The division shall have the following powers and duties:

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     (1) To conduct a census of local, state, and federal efforts to address Medicaid and public

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assistance fraud in this state, including fraud detection, prevention, and prosecution, in order to

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discern overlapping missions, maximize existing resources, and strengthen current programs;

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     (2) To develop a strategic plan for coordinating and targeting state and local resources for

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preventing and prosecuting Medicaid and public assistance fraud. The plan must identify methods

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to enhance multi-agency efforts that contribute to achieving the state’s goal of eliminating

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Medicaid and public assistance fraud;

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     (3) To identify methods to implement innovative technology and data sharing in

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consultation with the office of digital excellence in order to detect and analyze Medicaid and

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public assistance fraud with speed and efficiency;

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     (4) To develop and promote, in consultation with federal, state and local law enforcement

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agencies, crime prevention services and educational programs that serve the public; and

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     (5) To develop and implement training for all Medicaid provider and managed care

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organizations, concerning, but not limited to the following:

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     (i) Coverage and billing policies;

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     (ii) Participant-centered planning and options available;

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     (iii) Covered and non-covered services;

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     (iv) Provider accountability and responsibilities;

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     (v) Claim submission policies and procedures; and

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     (vi) Reconciling claim activity.

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     (d) The division shall annually prepare and submit a report on its activities and

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recommendations, by January 1, to the president of the senate, the speaker of the house of

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representatives, the governor, and the chairs of the house of representatives and senate finance

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committees.

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     SECTION 2. This act shall take effect upon passage.

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LC02683

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N A C T

RELATING TO STATE AFFAIRS AND GOVERNMENT - HEALTH AND HUMAN

SERVICES

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     This act would create a program integrity division within the office of health and human

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services to help prevent, detect, and prosecute Medicaid and public assistance fraud.

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     This act would take effect upon passage.

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LC02683

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