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HF 233

as introduced - 87th Legislature (2011 - 2012) Posted on 01/26/2011 10:53am

KEY: stricken = removed, old language.
underscored = added, new language.

Bill Text Versions

Introduction Posted on 01/26/2011

Current Version - as introduced

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A bill for an act
relating to state government; requiring the Department of Human Services
to issue a request for proposals for a Medicaid fraud detection and business
intelligence contract.


Section 1. new text beginREQUEST FOR PROPOSALS.
new text end

new text begin (a) The commissioner of human services shall issue a request for proposals
for a contract to use technologically advanced software and services to improve the
identification and rejection of improper Medicaid payments before payment is made to
the provider. The request for proposals must ensure that a system recommended and
implemented by the contractor will:
new text end

new text begin (1) implement a more comprehensive, robust, and technologically advanced
improper payments identification program;
new text end

new text begin (2) utilize state of the art fraud detection methods and technologies such as predictive
modeling, link analysis, and anomaly and outlier detection;
new text end

new text begin (3) have the ability to identify and report improper claims before the claims are paid;
new text end

new text begin (4) include a mechanism so that the system improves its detection capabilities over
new text end

new text begin (5) leverage technology to make the Medicaid claims evaluation process more
transparent and cost-efficient; and
new text end

new text begin (6) result in increased state savings by reducing or eliminating payouts of wrongful
Medicaid claims.
new text end

new text begin (b) Based on responses to the request for proposal, the commissioner must enter into
a contract for the services specified in paragraph (a) by October 1, 2011. The contract
shall incorporate a performance-based vendor financing option whereby the vendor shares
in the risk of the project's success.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end