,,ii #aad? ,,congress #b;d ,session ,s4 #bgja ,,9 ,,! ,,s5ate ,,( ,,! ,,unit$ ,,/ates ,m>* #ag1 #bjaf ,mr4 ,he9ri* 7= himself & ,mr4 ,udall7 introduc$ ! foll[+ bill2 :i* 0 read twice & ref]r$ to ! ,committee on ,f9ance ,a ,,bill ,to require consid]ation ( ! impact on b5efici>y access to c>e & to enhance due process protections 9 proc$ures = susp5d+ paym5ts to ,m$icaid provid]s4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,m$icaid ,program ,integrity ,enhancem5t ,act ( #bjaf4 #b4 ,revision ( regulations 7a7 ,9 g5]al ,n lat] ?an #ahj days aft] ! date ( enactm5t ( ?is section1 ! ,secret>y %all revise "p #dee ( title #db1 ,code ( ,f$]al ,regulations relat+ ,m$icaid program integrity z foll[s3 7#a7 ,section #dee4b relat+ to ! def9ition ( cr$ible allegation ( fraud to comply ) ! requirem5ts describ$ 9 subsection 7b74 7#b7 ,section #dee4bc relat+ to ! susp5sion ( ,m$icaid paym5ts to a provid] by a ,/ate ,m$icaid ag5cy to comply ) ! requirem5ts describ$ 9 subsection 7c74 7b7 ,requirem5t ,to consid] impact on b5efici>y access to c>e 9 det]m9+ a cr$ible allegation ( fraud ,! revis$ section #dee4b %all provide t an allegation %all be consid]$ to be a cr$ible allegation ( fraud only if-- 7#a7 ! allegation has indicia ( reliability2 7#b7 ! ,/ate ,m$icaid ag5cy has review$ all allegations1 facts1 & evid5ce c>efully & acts judici\sly on a case-by-case basis2 & 7#c7 ! ,/ate ,m$icaid ag5cy has tak5 into consid]ation ! pot5tial impact a paym5t susp5sion may h on b5efici>y access to c>e4 7c7 ,due process requirem5ts = paym5t susp5sion bas$ on cr$ible allegation ( fraud 7#a7 ,process requir$ be=e susp5sion ,a ,/ate ,m$icaid ag5cy t has receiv$ an allegation ( fraud aga9/ a provid] %all n susp5d paym5ts to su* provid] until ! ag5cy takes ! foll[+ actions3 7,a7 ,! ,/ate ,m$icaid ag5cy consults ) ! ,m$icaid fraud control unit = ! ,/ate or1 if ! ,/ate has no ,m$icaid fraud control unit1 ! ,/ate attorney g5]al1 be=e susp5d+ paym5ts & receives a writt5 v]ification f ! ,m$icaid fraud control unit or attorney g5]al1 9 su* =m z ! ,secret>y may require1 confirm+ t su* consultation took place4 7,b7 ,! ,/ate ,m$icaid ag5cy c]tifies to ! ,secret>y t x has consid]$ :e!r-- 7i7 b5efici>y access to items or s]vices w\ld be jeop>diz$ by a paym5t susp5sion2 7ii7 a good cause n to susp5d paym5ts exi/s "u section #dee4bc7;e7 ( title #db1 ,code ( ,f$]al ,regulations 7z revis$ aft] ! application ( ?is ,act72 & 7iii7 a good cause to susp5d paym5ts only 9 "p exi/s "u section #dee4bc7;f7 ( su* title ( su* ,code 7z s revis$74 7,c7 ,! ,/ate ,m$icaid ag5cy furni%es ! provid] ) ! ag5cy's reasons = f9d+ t !re is no good cause to refra9 f susp5d+ paym5ts 9 :ole or "p4 7#b7 ,process requir$ aft] susp5sion ,aft] a ,/ate ,m$icaid ag5cy susp5ds paym5ts 79 :ole or "p7 to a provid] on ! basis t ! ag5cy has det]m9$ t !re is a cr$ible allegation ( fraud aga9/ a provid] = :i* an inve/igation is p5d+ "u ! ,m$icaid program1 ! ag5cy %all take ! foll[+ actions3 7,a7 ,at ! beg9n+ ( ea* fiscal qu>t] t beg9s aft] paym5ts to ! provid] h be5 susp5d$1 ! ,/ate ,m$icaid ag5cy %all-- 7i7 c]tify to ! ,secret>y t x has consid]$ :e!r ! susp5sion ( paym5ts %\ld be t]m9at$ or modifi$ because-- 7,i7 a good cause n to susp5d paym5ts exi/s "u section #dee4bc7;e7 ( title #db1 ,code ( ,f$]al ,regulations 7z revis$ aft] ! application ( ?is ,act72 or 7,,ii7 a good cause to susp5d paym5ts only 9 "p exi/s "u section #dee4bc7;f7 ( su* title 7z s revis$72 & 7ii7 if ! ag5cy f9ds t !re is no good cause to t]m9ate or modify ! susp5sion ( paym5ts1 furni% to ! provid] ! ag5cy's reasons = su* f9d+4 7,b7 ,if ! inve/igation is n resolv$ 9 a reasonable am\nt ( "t 7z det]m9$ by ! ,secret>y71 ! ,/ate ,m$icaid ag5cy %all disclose to ! provid] ! specific allegations ( fraud t =m$ ! basis = ! ag5cy's det]m9ation t !re is a cr$ible allegation ( fraud aga9/ ! provid]4 7,c7 ,e #ahj days aft] ! initiation ( a susp5sion ( paym5ts bas$ on cr$ible allegations ( fraud1 a ,/ate ,m$icaid ,ag5cy %all-- 7i7 evaluate :e!r !re is good cause to n cont9ue su* susp5sion2 & 7ii7 reque/ a c]tification f ! ,m$icaid fraud control unit = ! ,/ate or1 if ! ,/ate has no ,m$icaid fraud control unit1 ! ,/ate attorney g5]al1 or o!r law en=cem5t ag5cy t ! matt] cont9ues to be "u inve/igation w>rant+ cont9uation ( ! susp5sion4 7,d7 ,good cause n to cont9ue to susp5d paym5ts to an individual or entity aga9/ :i* !re are cr$ible allegations ( fraud %all be deem$ to exi/ if a paym5t susp5sion has be5 9 effect = #ah mon?s & !re has n be5 a resolution ( ! inve/igation1 except a ,/ate ,m$icaid ,ag5cy may ext5d a paym5t susp5sion beyond su* p]iod if -- 7i7 ! case has be5 ref]r$ to1 & is be+ consid]$ by1 ! ,m$icaid fraud control unit = ! ,/ate or1 if ! ,/ate has no ,m$icaid fraud control unit1 ! ,/ate attorney g5]al1 = adm9i/rative action or su* adm9i/rative action is p5d+2 or 7ii7 ! ,m$icaid fraud control unit = ! ,/ate or1 if ! ,/ate has no ,m$icaid fraud control unit1 ! ,/ate attorney g5]al1 submits a writt5 reque/ to ! ,/ate ,m$icaid ,ag5cy t ! susp5sion ( paym5ts be cont9u$ bas$ on ! ongo+ inve/igation & anticipat$ fil+ ( crim9al or civil action or bo? or bas$ on a p5d+ crim9al or civil action or bo?4 ,at a m9imum1 ! reque/ %all include ! foll[+3 7,i7 ,id5tification ( ! entity "u susp5sion4 7,,ii7 ,! am\nt ( "t ne$$ = cont9u$ susp5sion 9 ord] to conclude ! crim9al or civil proce$+ or bo?4 7,,iii7 ,a /atem5t ( :y or h[ crim9al or civil action or bo? may be affect$ if ! reque/$ ext5sion is n grant$4 7d7 ,def9itions ,= purposes ( ?is section3 7#a7 ,! t]m ,m$icaid fraud control unit means a ,/ate ,m$icaid fraud control unit z def9$ 9 section #aijc7q7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7q774 7#b7 ,! t]m ,secret>y means ! ,secret>y ( ,heal? & ,human ,s]vices4 7#c7 ,! t]m ,/ate ,m$icaid ag5cy means ! ag5cy responsible = adm9i/]+ a ,/ate plan "u title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq474 #c4 ,appeals process 7a7 ,9 g5]al ,section #aijb7;a77#ci7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#ci77 is am5d$-- 7#a7 by /rik+ %all exclude & ins]t+ 8%all-- 7,a7 exclude 2 7#b7 by add+ & aft] ! semicolon at ! end2 & 7#c7 by add+ at ! end ! foll[+ new subp>agraph3 7,b7 e/abli% & codify a process :]eby a provid] to :om paym5ts h be5 susp5d$1 9 :ole or "p1 on ! basis ( cr$ible allegations ( fraud aga9/ su* provid] may appeal any decision 7includ+ a decision n to t]m9ate or modify a paym5t susp5sion t is already 9 place7 by ! ,/ate ag5cy t no good cause exi/s "u ! regulations ( ! ,secret>y to t]m9ate1 modify1 or refra9 f impos+ su* susp5sion ( paym5t2 4 7b7 ,effective date 7#a7 ,9 g5]al ,subject to p>agraph 7#b71 ! am5dm5ts made by ?is section %all take effect on ! date t is #a ye> aft] ! date ( ! enactm5t ( ?is ,act4 7#b7 ,delay p]mitt$ if ,/ate legislation requir$ ,9 ! case ( a ,/ate plan approv$ "u title ,,xix ( ! ,social ,security ,act :i* ! ,secret>y ( ,heal? & ,human ,s]vices det]m9es requires ,/ate legislation 7o!r ?an legislation appropriat+ funds7 9 ord] = ! plan to meet ! additional requirem5ts impos$ by ?is section1 ! ,/ate plan %all n be reg>d$ z fail+ to comply ) ! requirem5ts ( su* title solely on ! basis ( ! failure ( ! plan to meet su* additional requirem5ts be=e ! fir/ day ( ! fir/ cal5d> qu>t] beg9n+ aft] ! close ( ! fir/ regul> session ( ! ,/ate legislature t ends aft] ! #a-ye> p]iod beg9n+ ) ! date ( ! enactm5t ( ?is section4 ,= purposes ( ! prec$+ s5t5ce1 9 ! case ( a ,/ate t has a #b-ye> legislative session1 ea* ye> ( ! session is deem$ to be a sep>ate regul> session ( ! ,/ate legislature4