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THE SENATE |
S.B. NO. |
2166 |
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TWENTY-SIXTH LEGISLATURE, 2012 |
S.D. 2 |
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STATE OF HAWAII |
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A BILL FOR AN ACT
RELATING TO MEDICAID.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. The legislature finds that waste, fraud, and abuse cost state medicaid programs an estimated $18,000,000,000 per year nationwide. In most states, the common practice is to pay claims and thereafter attempt to recover payments for claims that are later found to be illegitimate. This pay-and-chase model is extremely inefficient because it is more difficult to recover payments than it is to deny illegitimate claims before payments are made. One way to combat this problem is to implement modern screening and prevention solutions to detect fraud and abuse before illegitimate claims are paid.
The legislature also finds that implementing measures to detect and prevent waste, fraud, and abuse in the State's medicaid and children's health insurance programs will improve the department of human services' ability to effectively administer the programs and reduce costs. The measures will also comply with program integrity provisions of the federal Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010, promulgated in the Centers for Medicare and Medicaid Services Final Rule 6028.
The purpose of this Act is to create the health insurance waste, fraud, and abuse task force within the department of human services to detect fraud and abuse before payments of illegitimate claims are made under the medicaid programs, including the medicaid managed care and children's health insurance programs.
SECTION 2. (a) There shall be established within the department of human services, the health insurance waste, fraud, and abuse task force. The task force shall develop strategies and plan and coordinate efforts to detect and prevent fraud and abuse before payments of illegitimate claims are made under the medicaid programs, including the medicaid managed care and children's health insurance programs.
(b) The health insurance waste, fraud, and abuse task force shall meet quarterly at a place and time to be determined by the chair of the task force. Meeting notices shall be posted by the task force as required by chapter 92, Hawaii Revised Statutes, and public testimony at meetings shall be accepted by the task force; provided that no other provision of chapter 92, part I, Hawaii Revised Statutes, shall apply. The task force shall be dissolved on July 1, 2013.
(c) The department of human services shall provide administrative support, including the recording of minutes, to the health insurance waste, fraud, and abuse task force.
(d) The director of human services or the director's designee shall be the chair of the health insurance waste, fraud, and abuse task force. The task force shall include the following members or their designees, to be appointed by the director of human services without regard to section 26-34, Hawaii Revised Statutes:
(1) The director of human services;
(2) The director of health;
(3) A member of the house of representatives appointed by the speaker of the house of representatives;
(4) A member of the senate appointed by the president of the senate;
(5) Two representatives from consumer advocate groups, who shall be requested to serve;
(6) Two representatives from hospitals, who shall be requested to serve; and
(7) Two representatives from health plans, who shall be requested to serve.
The members of the task force shall serve without compensation, and all necessary expenses, including travel expenses, shall be paid by the agency, organization, or department to which the member belongs. No member shall be made subject to chapter 84, Hawaii Revised Statutes, solely because of that member's participation as a member of the task force.
(e) The health insurance waste, fraud, and abuse task force, in conjunction with the department of human services, shall submit a report of its findings and recommendations, including proposed legislation, if any, to the legislature no later than twenty days prior to the convening of the regular session of 2013.
SECTION 3. This Act shall take effect on July 1, 2012.
Report Title:
Medicaid; Children's Health Insurance Program; Fraud Prevention and Detection
Description:
Establishes the Health Insurance Waste, Fraud, and Abuse Task force to detect fraud and abuse before payments of illegitimate claims are made under the medicaid programs, including medicaid managed care and children's health insurance. Requires task force to report to 2013 legislature. (SD2)
The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.