Chapter 264

2013 -- H 6134

Enacted 07/15/13

A N A C T

RELATING TO STATE AFFAIRS AND GOVERNMENT - HEALTH AND HUMAN

SERVICES

Introduced By: Representatives Azzinaro, Corvese, McNamara, and Malik

Date Introduced: May 16, 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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LC02115

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