,i  #aai? ,,congress  #b;d ,session  ,h4
 ,r4 #ajfcf  ,,9 ,,! ,,h\se ,,(         
,,repres5tatives  ,septemb] #bh1        
#bjbf,mr4 ,rulli 7= himself1 ,mr4 ,b5tz1
 ,mr4 ,c>t] ( ,georgia1 ,mrs4 ,fis*ba*1 
,mr4 ,taylor1 & ,mr4 ,biggs ( ,arizona7 
introduc$ ! foll[+ bill2 :i* 0 ref]r$ to
 ! ,committee on ,en]gy & ,comm]ce  ,a  
,,bill  ,to am5d title ,,xix ( ! ,social
 ,security ,act to require ,/ates to    
conduct fraud risk assessm5ts "u !      
,m$icaid program4  #a4 ,%ort title ,?is 
,act may be cit$ z ! ,m$icaid ,fraud    
,prev5tion ,act4  #b4 ,requir+ ,m$icaid 
fraud risk assessm5ts ,section #aijb ( !
 ,social ,security ,act 7#db ,u4,s4,c4  
#acif;a7 is am5d$--  7#a7 9 subsection  
7a7-- 7,a7 9 p>agraph 7#hi71 by /rik+ & 
at ! end2  7,b7 9 p>agraph 7#ij71 by    
/rik+ ! p]iod at ! end & ins]t+ 2 &2 &  
7,c7 by ins]t+ aft] p>agraph 7#ij7 !    
foll[+ new p>agraph3  7#ia7 provide t ! 
,/ate %all comply ) ! fraud risk        
assessm5t requirem5ts "u subsection     
7zz74  2 &  7#b7 by add+ at ! end !     

foll[+ new subsection3  7zz7 ,fraud risk
 assessm5t requirem5ts  7#a7 ,9 g5]al ,=
 purposes ( subsection 7a77#ia71 ! fraud
 risk assessm5t requirem5ts "u ?is      
subsection are t ! ,/ate %all-- 7,a7 n  
lat] ?an #a ye> aft] ! date ( ! enactm5t
 ( ?is subsection & n less frequ5tly ?an
 annually !reaft]1 complete a fraud risk
 assessm5t z describ$ 9 p>agraph 7#b72  
7,b7 n lat] ?an #ij days aft] complet+  
su* an assessm5t1 implem5t a corrective 
action plan to address any              
vuln]abilities id5tifi$ 9 su* assessm5t 
t includes measurable outcomes &        
specific deadl9es ) respect to !        
completion ( corrective actions "u su*  
plan2 &  7,c7 n lat] ?an #a ye> aft] !  
completion ( ! fir/ fraud risk assessm5t
 "u ?is subsection1 & annually !reaft]1 
submit to ! ,secret>y a report t        
includes ! in=mation specifi$ 9 p>agraph
 7#c7 ) respect to ! prec$+ ye>4  7#b7  
,fraud risk assessm5t describ$  7,a7 ,9 
g5]al ,= purposes ( p>agraph 7#a71 a    
fraud risk assessm5t describ$ 9 ?is     

p>agraph is a compreh5sive assessm5t (  
fraud risks across all compon5ts ( !    
,/ate plan 7& any waiv] ( su* plan71    
includ+ ) respect to m$ical assi/ance   
provid$ on a fee-=-s]vice basis1 m$ical 
assi/ance provid$ ?r\gh a manag$ c>e    
entity1 & eligibility det]m9ation &     
enrollm5t sy/ems 7includ+ sy/ems op]at$ 
by or on behalf ( ! ,/ate = ! purposes (
 eligibility v]ification & r$et]m9ation7
 "u su* plan 7or waiv]71 t-- 7i7 to !   
ext5t practicable1 uses data f exi/+    
,f$]al & ,/ate program integrity sy/ems1
 includ+--  7,i7 ! ,paym5t ,error ,rate 
,measurem5t program 7or any successor   
program72  7,,ii7 ! ,trans=m$ ,m$icaid  
,/ati/ical ,in=mation ,sy/em 7or any    
successor sy/em72  7,,iii7 manag$ c>e   
enc\nt] data2  7,,iv7 data f a ,/ate    
m$icaid fraud control unit 7z def9$ 9   
section #aijc7q77 or ano!r program      
integrity activity2  7,v7 ! ,public     
,assi/ance ,report+ ,in=mation ,sy/em   
7,,p>is7 7or any successor sy/em72 &    
7,,vi7 beg9n+ ,octob] #a1 #bjbi1 ! sy/em

 e/abli%$ by ! ,secret>y "u subsection  
7uu72  7ii7 id5tifies & ranks ! mo/     
significant fraud1 wa/e1 & abuse        
vuln]abilities ( su* plan 7or waiv]72   
7iii7 e/imates ! am\nt t c\ld pot5tially
 be improp]ly exp5d$ "u su* plan 7or    
waiv]7 due to ea* su* vuln]ability1     
includ+ any improp] paym5ts associat$ ) 
ea* su* vuln]ability1 ) respect to1 at  
m9imum1 ! #ab-mon? p]iod beg9n+ on !    
date on :i* su* assessm5t is complet$2  
7iv7 evaluates ! effectiv5ess ( exi/+   
program integrity tools "u su* plan 7or 
waiv]72  7v7 id5tifies gaps 9 data %>+1 
ov]sight1 & en=cem5t ) respect to fraud1
 wa/e1 & abuse "u su* plan 7or waiv]72 &
  7vi7 foll[s ! guidel9es e/abli%$ by ! 
,secret>y "u subp>agraph 7,b74  7,b7    
,e/abli%m5t ( guidel9es ,n lat] ?an     
,janu>y #a1 #bjbg1 ! ,secret>y %all     
e/abli% guidel9es t--  7i7 id5tify &    
def9e /&>diz$ categories ( fraud1 wa/e1 
& abuse risk across ,/ate plans 7&      
waiv]s ( su* plans71 includ+ ) respect  
to eligibility det]m9ations1 provid]    

enrollm5ts1 claims process+1 & manag$   
c>e2  7ii7 e/abli% crit]ia = !          
id5tification1 scor+1 & prioritization (
 categories ( risk id5tifi$ "u clause   
7i7 on ! basis ( ! likelihood ( su*     
risks & e/imates ( pot5tial improp]     
exp5ditures 7z describ$ 9 subp>agraph   
7,a77iii77 due to su* risks2 &  7iii7   
enable fraud risk assessm5ts complet$ "u
 ?is subsection by diff]5t ,/ates to be 
effectively comp>$4  7#c7 ,in=mation    
specifi$ ,= purposes ( p>agraph 7#a71 ! 
in=mation specifi$ 9 ?is p>agraph is--  
7,a7 ! results ( any fraud risk         
assessm5ts conduct$ "u p>agraph         
7#a77;,a72  7,b7 ! mo/ significant      
fraud1 wa/e1 & abuse vuln]abilities     
id5tifi$ "u su* assessm5ts2  7,c7 !     
pot5tial improp] exp5ditures 7z describ$
 9 p>agraph 7#b77;,a77iii77 e/imat$ "u  
su* assessm5ts2  7,d7 corrective actions
 tak5 or plann$ to be tak5 "u p>agraph  
7#a77;,b7 ) respect to su*              
vuln]abilities2 &  7,e7 an explanation (
 any progress made 9 address+ su*       

vuln]abilities4  7#d7 ,annual report to 
,congress ,n lat] ?an #a ye> aft] ! date
 on :i* ! fir/ report "u p>agraph       
7#a77;,c7 is submitt$ to ! ,secret>y1 & 
annually !reaft]1 ! ,secret>y %all      
submit to ,congress a report t1 )       
respect to ! prec$+ ye>--  7,a7 analyzes
 ! f9d+s f reports submitt$ to !        
,secret>y "u su* p>agraph2  7,b7        
id5tifies national tr5ds ) respect to   
,m$icaid fraud risk2  7,c7 evaluates    
,/ate implem5tation ( corrective action 
plans implem5t$ "u p>agraph 7#a77;,b72 &
  7,d7 includes recomm5dations =        
legislative or adm9i/rative action to   
address fraud1 wa/e1 & abuse            
vuln]abilities id5tifi$ 9 su* reports4  
4