Senate Bill 2224

AN ACT TO AMEND SECTION 43-13-219, MISSISSIPPI CODE OF 1972, TO AUTHORIZE AND DIRECT THE DIVISION OF MEDICAID TO ESTABLISH AN ENHANCED ELIGIBILITY VERIFICATION SYSTEM WHICH WILL VERIFY RESIDENCY AND ELIGIBILITY OF RECIPIENTS AND REMOVE INELIGIBLE RECIPIENTS FROM THE MEDICAID ROLLS; AND FOR RELATED PURPOSES.

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

SECTION 1. Section 43-13-219, Mississippi Code of 1972, is amended as follows:

43-13-219. (1) There is hereby created within the Office of the Attorney General a "Medicaid Fraud Control Unit." The unit shall consist of a director appointed by the Attorney General and such attorneys, auditors, investigators and other such personnel as are necessary to conduct the activities of the unit.

(2) The Division of Medicaid shall establish a computerized income, asset, residence and identity eligibility verification system in order to verify eligibility, eliminate the duplication of assistance, and deter waste, fraud, and abuse within each respective assistance program administered by the division. The division shall enter into a competitively bid contract with a third-party vendor for the purposes of developing a system by which to verify the income, asset, residence and identity eligibility of applicants to prevent fraud, misrepresentation, and inadequate documentation when determining an applicant's eligibility for assistance prior to the distribution of benefits, periodically between eligibility redeterminations, and during eligibility redeterminations and reviews, as prescribed in this section. The division may also contract with a vendor to provide information to facilitate reviews of recipient eligibility conducted by the division. When the division enters into a contract with a third-party vendor for the purposes of carrying out this section, the vendor, in partnership with the division, shall be required by contract to establish annualized savings realized from implementation of the verification system and savings shall exceed the total yearly cost to the state for implementing the verification system. It is the intent of the Legislature that any recipient who has moved out of state shall be deleted from the rolls of eligible recipients within three (3) months of their change of residency.

When the division enters into a contract with a third-party vendor, the payment structure should be based on a per-applicant rate and a performance bonus for achieving above a predetermined rate of success of identifying waste, fraud and abuse. To avoid any conflict of interest, when the division enters into a contract with a third-party vendor, that primary vendor may not currently or will not be allowed to bid on or be awarded a state contract to run enrollment services. Nothing in this section shall preclude the division from continuing to conduct additional eligibility verification processes, not detailed in this section, that are currently in practice.

SECTION 2. This act shall take effect and be in force from and after July 1, 2016.