Chapter 368
2013 -- S 0833
Enacted 07/15/13
A N A C T
RELATING TO
STATE AFFAIRS AND GOVERNMENT - HEALTH AND HUMAN
SERVICES
Introduced
By: Senators
Date Introduced: April 04, 2013
It is enacted by the
General Assembly as follows:
SECTION 1. Chapter 42-7.2 of the General Laws entitled
"Office of Health and Human
Services" is hereby
amended by adding thereto the following section:
42-7.2-18.
Program integrity division. -- (a) There is hereby established a program
integrity division within the office of health and human
services to effectuate the transfer of
functions pursuant to subdivision 42-7.2-6.1(a)(7). The
purposes of this division are:
(1) To develop and
implement a statewide strategy to coordinate state and local agencies,
law enforcement entities, and investigative units in
order to increase the effectiveness of
programs and initiatives dealing with the prevention,
detection, and prosecution of Medicaid and
public assistance fraud; and
(2) To oversee and
coordinate state and local efforts to investigate and eliminate
Medicaid and public assistance
fraud and to recover state and federal funds.
(b) The program
integrity division shall provide advice and make recommendations, as
necessary, to the secretary of health and human services and
all departments assigned to the office
to effectuate the purposes of the division.
(c) The division
shall have the following powers and duties:
(1) To conduct a
census of local, state, and federal efforts to address Medicaid and public
assistance fraud in this state, including fraud detection,
prevention, and prosecution, in order to
discern overlapping missions, maximize existing resources,
and strengthen current programs;
(2) To develop a
strategic plan for coordinating and targeting state and local resources for
preventing and prosecuting Medicaid and public assistance fraud.
The plan must identify methods
to enhance multi-agency efforts that contribute to
achieving the state’s goal of eliminating
Medicaid and public assistance fraud;
(3) To identify
methods to implement innovative technology and data sharing in
consultation with the office of digital excellence in order to
detect and analyze Medicaid and
public assistance fraud with speed and efficiency;
(4) To develop and
promote, in consultation with federal, state and local law enforcement
agencies, crime prevention services and educational programs
that serve the public; and
(5) To develop and
implement training for all Medicaid provider and managed care
organizations, concerning, but not limited to the following:
(i)
Coverage and billing policies;
(ii)
Participant-centered planning and options available;
(iii) Covered and
non-covered services;
(iv)
Provider accountability and responsibilities;
(v) Claim submission
policies and procedures; and
(vi)
Reconciling claim activity.
(d) The division shall
annually prepare and submit a report on its activities and
recommendations, by January 1, to the president of the senate, the
speaker of the house of
representatives, the governor, and the chairs of the house of
representatives and senate finance
committees.
SECTION 2. This act shall take effect upon passage.
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LC02150
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