SF 1756

as introduced - 89th Legislature (2015 - 2016) Posted on 03/17/2015 09:10am

A bill for an act
relating to human services; requiring the commissioner of human services to
contract with a vendor for eligibility verification audit services for public health
care programs.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1. PUBLIC HEALTH CARE PROGRAM ELIGIBILITY
VERIFICATION AUDIT SERVICES.

Subdivision 1.

Request for proposals.

By October 1, 2015, the commissioner of
human services shall issue a request for proposals for a contract to provide eligibility
verification audit services for public health care program benefits provided through the
state medical assistance and MinnesotaCare programs. The request for proposals must
require that the vendor:

(1) conduct an eligibility verification audit of all medical assistance and
MinnesotaCare enrollees that includes, but is not limited to, appropriate data matching
against relevant state and federal databases;

(2) identify any ineligible enrollees in these programs and report those findings
to the commissioner; and

(3) identify a process for ongoing eligibility verification of medical assistance
and MinnesotaCare enrollees and applicants, following the conclusion of the eligibility
verification audit required by this section.

Subd. 2.

Additional vendor criteria.

The request for proposals must require the
vendor to provide the following minimum capabilities and experience in performing the
services described in subdivision 1:

(1) a rules-based process for making objective eligibility determinations;

(2) assigned eligibility advocates to assist enrollees through the verification process;

(3) a formal claims and appeals process; and

(4) experience in the performance of eligibility verification audits.

Subd. 3.

Contract required.

By January 1, 2016, the commissioner must enter
into a contract for the services specified in subdivision 1. The contract may incorporate
a performance-based vendor financing option that compensates the vendor based on the
amount of savings generated by the work performed under the contract.