,,ii  #aai? ,,congress  #b;d ,session   
,s4 #cgbg  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,janu>y #bi1 #bjbf,ms4 
,ern/ introduc$ ! foll[+ bill2 :i* 0    
read twice & ref]r$ to ! ,committee on  
,f9ance  ,a ,,bill  ,to combat fraud 9  
,f$]al programs1 & = o!r purposes4  #a4 
,%ort title ,?is ,act may be cit$ z !   
,putt+ an ,n to ,le>+ ab\t ,fraud ,act4 
#b4 ,prev5t+ fraud 9 *ild c>e s]vices   
7a7 ,/ate plan ,section #feh;,e ( !     
,*ild ,c>e & ,developm5t ,block ,grant  
,act ( #aiij 7#db ,u4,s4,c4 #iheh;c7 is 
am5d$-- 7#a7 9 subsection 7c77#b71 by   
add+ by /rik+ subp>agraph 7,s7 & ins]t+ 
! foll[+3  7,s7 ,att5dance-bas$ bill+ ,!
 plan %all include an assurance t ! lead
 ag5cy w provide paym5t "u ?is sub*apt] 
to a *ild c>e provid] bas$ on record$   
att5dance1 r ?an enrollm5t alone1 9 !   
program ( ! provid]4  2 &  7#b7 by add+ 
at ! end ! foll[+3  7e7 ,tim+ ( paym5t  
,no?+ 9 ?is sub*apt] %all be con/ru$ to 
require a lead ag5cy to make a paym5t to
 a *ild c>e provid] prior to ! provision

 ( *ild c>e s]vices4 ,! lead ag5cy %all 
make a paym5t "u ?is sub*apt] to su* a  
provid] z reimbursem5t1 9 a timely      
mann]1 & on ! basis ( ! provid]'s       
provision ( *ild c>e s]vices4  4  7b7   
,audits ,section #feh,k ( ! ,*ild ,c>e &
 ,developm5t ,block ,grant ,act ( #aiij 
7#db ,u4,s4,c4 #iheh;i7 is am5d$ by add+
 at ! end ! foll[+3  7c7 ,f$]al audits  
,ea* *ild c>e provid] t receives a      
paym5t "u ?is sub*apt] %all prep>e a    
record ( att5dance 9 ! provid]'s program
 & ( ! provid]'s provision ( *ild c>e   
s]vices1 & ma9ta9 ! record = a p]iod (  
#g ye>s aft] ! date ( prep>ation ( su*  
record4 ,! provid] %all make su* records
 available = audits by ! ,secret>y1 !   
,attorney ,g5]al1 & ! ,comptroll] ,g5]al
 ( ! ,unit$ ,/ates4  4  #c4 ,id5tify+   
fraud 9 heal? c>e s]vices  7a7 ,m$ic>e  
7#a7 ,9 g5]al ,! ,secret>y ( ,heal? &   
,human ,s]vices %all1 n lat] ?an #fj    
days aft] mak+ a det]m9ation describ$ 9 
p>agraph 7#b71 notify ! ,inspector      
,g5]al ( ! ,dep>tm5t ( ,heal? & ,human  

,s]vices ( su* det]m9ation4  7#b7       
,det]m9ation ,a det]m9ation describ$ 9  
?is p>agraph is a det]m9ation t-- 7,a7 !
 aggregate am\nt paid "u ! ,m$ic>e      
program "u title ,,xviii ( ! ,social    
,security ,act 7#db ,u4,s4,c4 #acie et  
seq47 = an item or s]vice or items or   
s]vices 9 a zip code & c\nty or c\nty   
equival5t increas$ by m ?an #ajj p]c5t 9
 a s+le ye>2 or  7,b7 ! numb] ( provid] 
( s]vices or suppli]s 7z ^? t]ms are    
def9$ "u section #ahfa ( ! ,social      
,security ,act 7#db ,u4,s4,c4 #aciex77  
:o receiv$ paym5t = items or s]vices    
furni%$ "u ! ,m$ic>e program increas$ 9 
a zip code & c\nty or c\nty equival5t by
 m ?an #ajj p]c5t 9 a s+le ye>4  7b7    
,qualifi$ heal? plans "u ! ,am]ican     
,heal? ,b5efit ,ex*anges  7#a7 ,9 g5]al 
,! ,secret>y ( ,heal? & ,human ,s]vices 
%all1 n lat] ?an #fj days aft] mak+ a   
det]m9ation describ$ 9 p>agraph 7#b71   
notify ! ,inspector ,g5]al ( ! ,dep>tm5t
 ( ,heal? & ,human ,s]vices ( su*       
det]m9ation4  7#b7 ,det]m9ation ,a      

det]m9ation describ$ 9 ?is p>agraph is a
 det]m9ation t-- 7,a7 ! aggregate am\nt 
paid "u all qualifi$ heal? plans (f]$   
?r\gh ! ,am]ican ,heal? ,b5efit         
,ex*anges e/abli%$ "u sections #acaa &  
#acba ( ! ,pati5t ,protection &         
,af=dable ,c>e ,act 7#db ,u4,s4,c4      
#ahjca1 #ahjda7 = an item or s]vice or  
items or s]vices 9 a zip code & c\nty or
 c\nty equival5t increas$ by m ?an #ajj 
p]c5t 9 a s+le ye>2 or  7,b7 ! numb] (  
provid]s ( s]vices :o receiv$ paym5t =  
items or s]vices "u su* qualifi$ heal?  
plans increas$ 9 a zip code & c\nty or  
c\nty equival5t by m ?an #ajj p]c5t 9 a 
s+le ye>4  7#c7 ,requirem5t to submit   
c]ta9 in=mation ,annually1 ea* ,am]ican 
,heal? ,b5efit ,ex*ange e/abli%$ "u     
section #acaa or #acba ( ! ,pati5t      
,protection & ,af=dable ,c>e ,act 7#db  
,u4,s4,c4 #ahjca1 #ahjda7 %all collect f
 ea* qualifi$ heal? plan (f]$ ?r\gh su* 
an ,ex*ange1 & submit to ! ,secret>y (  
,heal? & ,human ,s]vices1 ! in=mation   
necess>y = ! ,secret>y to make a        

det]m9ation describ$ 9 p>agraph 7#b74   
7c7 ,m$icaid & ,,*ip  7#a7 ,m$icaid     
,section #aijb ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #acif;a7 is am5d$-- 
7,a7 9 subsection 7a7-- 7i7 9 p>agraph  
7#hh71 by /rik+ 2 & & ins]t+ a          
semicolon2  7ii7 9 p>agraph 7#hi71 by   
/rik+ ! p]iod at ! end & ins]t+ 2 &2 &  
7iii7 by add+ aft] p>agraph 7#hi7 !     
foll[+ new p>agraph3  7#ij7 provide t1 n
 lat] ?an #fj days aft] mak+ a          
det]m9ation describ$ 9 subsection 7yy71 
! ,/ate ag5cy %all notify ! ,secret>y & 
! ,inspector ,g5]al ( ! ,dep>tm5t (     
,heal? & ,human ,s]vices ( su*          
det]m9ation4  2 &  7,b7 by add+ at ! end
 ! foll[+ new subsection3  7yy7         
,det]m9ation ( c]ta9 increas$ paym5ts or
 provid]s 9 a s+le ye> ,= purposes (    
subsection 7a77#ij71 a det]m9ation      
describ$ 9 ?is subsection is a          
det]m9ation t-- 7#a7 ! aggregate am\nt  
paid "u ! ,/ate plan "u ?is title1 or "u
 a waiv] ( su* plan1 = an item or s]vice
 or items or s]vices 9 a zip code &     

c\nty or c\nty equival5t increas$ by m  
?an #ajj p]c5t 9 a s+le ye>2 or  7#b7 ! 
numb] ( provid]s ( items or s]vices :o  
receiv$ paym5ts = items or s]vices      
furni%$ 9 a zip code & c\nty or c\nty   
equival5t "u su* ,/ate plan or waiv]    
increas$ by m ?an #ajj p]c5t 9 a s+le   
ye>4  4  7#b7 ,,*ip ,section            
#bajg7;e77#a7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acig;gg7e77#a77 is     
am5d$ by-- 7,a7 r$esignat+ subp>agraphs 
7,i7 ?r\gh 7,w7 z subp>agraphs 7,j7     
?r\gh 7,x71 respectively2 &  7,b7 ins]t+
 aft] subp>agraph 7,h7 ! foll[+         
subp>agraph3  7,i7 ,subsections 7a77#ij7
 & 7yy7 ( section #aijb 7relat+ to      
det]m9ation ( c]ta9 increas$ paym5ts or 
provid]s 9 a s+le ye> & notification to 
! ,secret>y & ! ,inspector ,g5]al (     
,heal? & ,human ,s]vices74  4  7d7      
,audit by ! ,inspector ,g5]al ( ,heal? &
 ,human ,s]vices ,n lat] ?an #e ye>s    
aft] ! date ( enactm5t ( ?is ,act1 &    
annually !reaft]1 ! ,inspector ,g5]al ( 
,heal? & ,human ,s]vices %all-- 7#a7    

id5tify1 bas$ on ! results ( any        
notifications receiv$ "u subsection 7a7 
or 7b71 or "u section #aijb7;a77#ij7 ( !
 ,social ,security ,act 7#db ,u4,s4,c4  
#acif;a7a77#ij77 or section             
#bajg7;e77#a77;,i7 ( su* ,act 7#db      
,u4,s4,c4 #acig;gg7e77#a77;,i771 any    
program or ,/ate plan or waiv] 79 ! case
 ( ,m$icaid & ! ,/ate ,*ildr5's ,heal?  
,insurance ,program7 "u :i* ! aggregate 
am\nt paid = an item or s]vice or items 
or s]vices 9 a zip code & c\nty or c\nty
 equival5t or ! numb] ( provid]s ( items
 or s]vices or suppli]s1 z applicable1  
:o receiv$ paym5ts = items or s]vices   
furni%$ 9 a zip code & c\nty or c\nty   
equival5t increas$ by at lea/ #djj p]c5t
 dur+ ! prec$+ #e-ye> p]iod2 &  7#b7    
audit any su* program1 ,/ate plan1 or   
waiv]4  7e7 ,effective date  7#a7       
,m$ic>e ,subsection 7a7 %all take effect
 on ! date t is #ahj days aft] ! date ( 
enactm5t ( ?is ,act4  7#b7 ,qualifi$    
heal? plans "u ! ,am]ican ,heal? ,b5efit
 ,ex*anges ,subsection 7b7 %all take    

effect on ! date t is #ahj days aft] !  
date ( enactm5t ( ?is ,act4  7#c7       
,m$icaid & ,,*ip  7,a7 ,9 g5]al ,except 
z provid$ 9 subp>agraph 7,b71 ! am5dm5ts
 made by subsection 7c7 %all take effect
 on ! date t is #ahj days 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 7#db   
,u4,s4,c4 #acif et seq47 or title ,,xxi 
( su* ,act 7#db ,u4,s4,c4 #acig;aa et   
seq47 :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 
! am5dm5ts made by subsection 7c71 !    
,/ate plan %all n be reg>d$ z fail+ to  
comply ) ! requirem5ts ( su* title ,,xix
 or ,,xxi 7z applicable7 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  #d4 ,recov]+   
improp] paym5ts  7a7 ,guidance ,!       
,director ( ! ,(fice ( ,managem5t &     
,budget %all prescribe guidance to all  
ag5cies 7z def9$ 9 section #eea ( title 
#e1 ,unit$ ,/ates ,code7 to ensure t all
 improp] paym5ts 7z def9$ 9 section     
#ccea ( title #ca1 ,unit$ ,/ates ,code7 
are recov]$4  7b7 ,annual ,inspector    
,g5]al report ,section #ccec7;a77#a7 (  
title #ca1 ,unit$ ,/ates ,code1 is      
am5d$-- 7#a7 9 subp>agraph 7,a71 by     
/rik+ & at ! end2  7#b7 9 subp>agraph   
7,b77iv71 by /rik+ ! p]iod at ! end &   
ins]t+ 2 &2 &  7#c7 by add+ at ! end !  
foll[+3  7,c7 include 9 ea* report      
submitt$ "u subp>agraph 7,b7 ! am\nt (  
improp] paym5ts recov]$ by ! executive  
ag5cy 9 ! fiscal ye> cov]$ by ! report4 

4