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WEST virginia legislature
2018 regular session
Introduced
House Bill 4417
By Delegates Ellington, Foster, Householder, Rohrbach, and Sypolt
[Introduced February 2, 2018;
Referred
to the Committee on Health and Human Resources then the Judiciary.]
A BILL to amend and reenact §9-2-6 of the Code of West Virginia, 1931, as amended; to amend and reenact §9-7-2, §9-7-5, and §9-7-6 of said code; to amend said code by adding thereto a new article, designated §9-8-1, §9-8-2, §9-8-3, §9-8-4, §9-8-5, §9-8-6, §9-8-7, §9-8-8, §9-8-9, §9-8-10, §9-8-11, §9-8-12, and §9-8-13; and to amend and reenact §61-3-54 of said code, all relating to investigations, inspections, evaluations, and review conducted by the Department of Health and Human Resources to prevent fraud and abuse; dis-enrolling providers who commit fraud and requiring repayment; defining fraud as it relates to Medicaid; authorizing penalties against providers for failure to keep medical records for a specific time period; authorizing a civil cause of action for fraud when a person or entity knew or should have known a claim to be false; enlarging the statute of limitations to file health care fraud civil actions; defining terms relating to public assistance fraud; providing for an asset test for SNAP benefits which authorizes the access of information of various federal, state, and miscellaneous sources; requiring cooperation with the Bureau for Child Support Enforcement; requiring a design or establishment of a computerized income, asset, and identity verification system for each public assistance program administered by the Department of Health and Human Resources; allowing for contracting with a third-party vendor; setting out required contract terms; requiring accessing information of various federal, state, and miscellaneous sources for eligibility verification; requiring identity authentication as a condition to receive public assistance; authorizing the department to study the feasibility of requiring photos on EBT cards; prohibiting payment of public assistance benefits in specified instances; setting forth notice requirements and right to a hearing; requiring referrals for fraud, misrepresentation, and inadequate documentation; authorizing referrals of suspected cases of fraud for criminal prosecution; requiring report to the Governor and Legislature; setting forth prohibitions on the use of an electronic benefit transfer card; tracking out-of-state spending of SNAP and TANF benefits; providing for rulemaking; and providing a penalty for taking the identity of another person for the purpose of gaining employment.
Be it enacted by the Legislature of West Virginia:
CHAPTER 9. HUMAN SERVICES.
ARTICLE 2. COMMISSIONER OF HUMAN SERVICES; POWERS, DUTIES, AND RESPONSIBILITIES GENERALLY.
§9-2-6. Powers of secretary.
Within limits of state appropriations and federal grants and subject to provisions of state and federal laws and regulations, the secretary, in addition to all other powers, duties, and responsibilities granted and assigned to that office in this chapter and elsewhere by law, is authorized to:
(1) Promulgate, amend, revise, and rescind department rules respecting the organization and government of the department and the execution and administration of those powers, duties, and responsibilities granted and assigned by this chapter and elsewhere by law to the department and the secretary.
(2) Promulgate, amend, revise, and rescind department rules and regulations respecting qualifications for receiving the different classes of welfare assistance consistent with or permitted by federal laws, rules, and policies, but not inconsistent with state law: Provided, That rules and policies respecting qualifications shall permit the expenditure of state funds to pay for care rendered in any birthing center licensed under the provisions of §16-2E-1 et seq. article of this code by a licensed nurse midwife or midwife as this occupation is defined in §30-15-1 of this code and which care is within the scope of duties for such licensed nurse midwife or midwife as permitted by the provisions of §30-15-7 of this code.
(3) Obtain by purchase or lease grounds, buildings, office, or other space, equipment, facilities, and services as may be necessary for the execution and administration of those powers, duties, and responsibilities granted and assigned by this chapter and elsewhere by law to the department and the secretary.
(4) Sign and execute in the name of the state by the State Department of Health and Human Resources any contract or agreement with the federal government or its agencies, other states, political subdivisions of this state, corporations, associations, partnerships, or individuals: Provided, That the provisions of §5A-3-1 et seq. are followed.
(5) Sign and execute a contract to implement professional health care, managed care, actuarial, and health care-related monitoring, quality review/utilization, claims processing, and independent professional consultant contracts for the Medicaid program: Provided, That the provisions of §5A-3-1 et seq. of this code are followed: Provided, however, That a contract awarded under the agency purchasing process from April 1, 2009, to January 2, 2013, remains in full force and effect and the secretary retains sole authority to review, approve, and issue changes to contracts issued under the former purchasing process, and is responsible for challenges, disputes, protests, and legal actions related to such contracts.
(6) Establish such special funds as may be required by the federal Social Security Act, as amended, or by any other Act or Acts of Congress, in order for this state to take full advantage of the benefits and provisions thereof relating to the federal-state assistance and federal assistance programs administered by the department and to make payments into and disbursements out of any such special fund or funds in accordance with the requirements of the federal Social Security Act, as amended, or any other act or Acts of Congress, and in accordance with applicable state law and the objects and purposes of this chapter. In addition, the State Department of Health and Human Resources, through the secretary, is hereby authorized to accept any and all gifts or grants, whether in money, land, services, or materials, which gift or gifts, if in the form of moneys, shall be placed in a separate fund and expended solely for the purpose of public assistance programs. No part of this special fund shall revert to the General Revenue Funds of this state. No expenses incurred pursuant to this special fund shall be a charge against the general funds of this state.
(7) Establish within the
department an office of inspector general for the purpose of conducting and
supervising investigations, performing inspections, evaluations, and review,
and for the purpose of providing quality control for the programs of the
department. The office of inspector general shall be headed by the inspector general
who shall report directly to the secretary. Neither the secretary nor any
employee of the department may prevent, inhibit, or prohibit the inspector general
or his or her employees from initiating, carrying out, or completing any
investigation, quality control inspection, evaluation, review, or
other activity oversight of public integrity by the office of the inspector general.
The secretary shall place within the office of inspector general any function
he or she deems necessary. Qualification, compensation, and personnel practice
relating to the employees of the office of the inspector general, including
that of the position of inspector general, shall be governed by the classified
service provisions of §29-6-1 of this code and rules promulgated thereunder.
The inspector general shall supervise all personnel of the office of inspector general.
(8) Provide at department expense a program of continuing professional, technical, and specialized instruction for the personnel of the department.
(9) Pay from available funds all or part of the reasonable expenses incurred by a person newly employed by the department in moving his household furniture, effects, and immediate family from his or her place of residence in this state to his or her place of employment in this state; and to pay from available funds all or part of the reasonable expenses incurred by a department employee in moving his or her household furniture, effects, and immediate family as a result of a reassignment of the employee which is considered desirable, advantageous to, and in the best interests of the state, but no part of the moving expenses of any one such employee shall be paid more frequently than once in 12 months or for any movement other than from one place of employment in this state to another place of employment in this state.
(10) Establish a program to provide reimbursement to employees of the department whose items of personal property, as defined by the department by policy, are damaged during the course of employment or other work-related activity as a result of aggressive behavior by a client or patient receiving services from the department: Provided, That such reimbursement is limited to a maximum amount of $250.00 per claim.
(11) Establish and maintain such institutions as are necessary for the temporary care, maintenance, and training of children and other persons.
(12) Prepare and submit state plans which will meet the requirements of federal laws, rules governing federal-state assistance and federal assistance, and which are not inconsistent with state law.
(13) Organize within the department a board of review, consisting of a chairman appointed by the secretary and as many assistants or employees of the department as may be determined by the secretary and as may be required by federal laws and rules respecting state assistance, federal-state assistance, and federal assistance, such board of review to have such powers of a review nature and such additional powers as may be granted to it by the secretary and as may be required by federal laws and rules respecting federal-state assistance and federal assistance.
(14) Provide by rules review and appeal procedures within the Department of Health and Human Resources as may be required by applicable federal laws and rules respecting state assistance, federal-state assistance and federal assistance, and as will provide applicants for, and recipients of all, classes of welfare assistance an opportunity to be heard by the Board of Review, a member thereof or individuals designated by the board, upon claims involving denial, reduction, closure, delay, or other action or inaction pertaining to public assistance.
(15) Provide by rules, consistent with requirements of applicable federal laws and rules, application forms and application procedures for the various classes of public assistance.
(16) Provide locations for making applications for the various classes of public assistance.
(17) Provide a citizen or group of citizens an opportunity to file objections and to be heard upon objections to the grant of any class of public assistance.
(18) Delegate to the personnel of the department all powers and duties vested in the secretary, except the power and authority to sign contracts and agreements.
(19) Make such reports in such form and containing such information as may be required by applicable federal laws and rules respecting federal-state assistance and federal assistance.
(20) Invoke any legal, equitable, or special remedies for the enforcement of the provisions of this chapter.
(21) Require a provider, subgrantee, or other entity performing services on behalf of the department to comply with all applicable laws, rules, and written policies pertaining to the program for which the entity is providing or coordinating services, including, but not limited to, policy manuals, statements of work, program instructions, or other similar agreements. When submitting a claim for payment, the entity shall certify that it has complied with all material conditions for payment. Submitting a claim or billing for services performed in violation of any law, rule, policy, or other written agreement shall constitute fraud and the agreement for provision of services shall terminate. The entity shall be required to repay the department for any payment under the program for which the provider was not entitled, regardless of whether the incorrect payment was the result of department error, fraud, or other cause. A demand for repayment shall be subject to due process procedures pursuant to §29A-5-1 et seq. of this code.
ARTICLE 7. FRAUD AND ABUSE IN THE MEDICAID PROGRAM.
§9-7-2. Definitions.
For the purposes of this article:
(1) “Assistance” means money payments, medical care, transportation, and other goods and services necessary for the health or welfare of individuals, including guidance, counseling, and other welfare services and shall include all items of any nature contained within the definition of “welfare assistance” in §9-1-2 of this code.
(2) “Benefits” means money payments, goods, services, or any other thing of value.
(3) “Board and Care Facility” means a residential setting where two or more unrelated adults receive nursing services or personal care services.
(4) “Claim” means an application for payment for goods or services provided under the medical programs of the Department of Health and Human Resources.
(5) “Entity” means any corporation, association, partnership, limited liability company, or other legal entity.
(6) “Financial Exploitation” means the intentional misappropriation or misuse of funds or assets of another.
(7) “Fraud” means a knowing misrepresentation, knowing concealment, or reckless statement of a material fact.
(7) (8) “Medicaid” means that assistance provided
under a state plan implemented pursuant to the provisions of 42 U.S.C. § 1396 et
seq. as that code has been and may hereafter be amended.
(8) (9) “Person” means any individual,
corporation, association, partnership, proprietor, agent, assignee, or entity.
(9) (10) “Provider” means any individual or entity
furnishing goods or services under the medical programs of the Department of
Health and Human Resources.
(10) (11) “Unit” means the Medicaid Fraud Control
Unit established under §9-7-1 of this code.
§9-7-5. Bribery; false claims; conspiracy; criminal penalties; failure to maintain records.
(a) A person shall not solicit, offer, pay, or receive any unlawful remuneration, including any kickback, rebate, or bribe, directly or indirectly, with the intent of causing an expenditure of moneys from the medical services fund established pursuant to §9-4-2 of this code, which is not authorized by applicable laws or rules and regulations.
(b) A person shall not make or present or cause to be made or presented to the Department of Health and Human Resources a claim under the medical programs of the Department of Health and Human Resources knowing the claim to be false, fraudulent, or fictitious.
(c) A person shall not enter into an agreement, combination, or conspiracy to obtain or aid another to obtain the payment or allowance of a false, fraudulent, or fictitious claim under the medical programs of the Department of Health and Human Resources.
(d) Any person found to be in violation of §9-7-5(a),
(b) or (c) of this code is guilty of a felony and, upon conviction, shall be imprisoned
in a state correctional facility not less than one nor more than 10 years or
shall be fined not to exceed $10,000, or both fined and imprisoned confined.
§9-7-6. Civil remedies; statute of limitations.
(a) Any person, firm, corporation, or other entity
which willfully, by means of a false statement or representation, or by
concealment of any material fact, or by other fraudulent scheme, devise or
artifice on behalf of himself, herself, itself, or others, obtains or attempts
to obtain benefits or payments or allowances under the medical programs of the
Department of Health and Human Resources to which he or she or it is not
entitled, or, in a greater amount than that to which he or she or it is
entitled makes or attempts to make, or causes to be made, a claim for
benefits, payments, or allowances under the medical programs of the Department
of Health and Human Resources, when such person, firm, corporation, or entity
knows, or reasonably should have known, such claim to be false, fictitious, or
fraudulent, or fails to maintain such records as are necessary, shall be
liable to the Department of Health and Human Resources in an amount equal to
three times the amount of such benefits, payments, or allowances to which he or
she or it is not entitled, and shall be liable for the payment of reasonable
attorney fees and all other fees and costs of litigation.
(b) No criminal action or indictment need be brought against any person, firm, corporation, or other entity as a condition for establishing civil liability hereunder.
(c) A civil action under this section may be prosecuted and maintained on behalf of the Department of Health and Human Resources by the attorney general and the attorney general's assistants or a prosecuting attorney and the prosecuting attorney's assistants or by any attorney in contract with or employed by the Department of Health and Human Resources to provide such representation.
(d) Any civil action brought under this section shall be brought within five years from the time the Medicaid Fraud Control Unit is made aware of the existence of the false, fraudulent, or fictitious claim from which a cause of action may arise.
article 8. eligibility and fraud requirements for public assistance.
§9-8-1. Definitions.
The following words have the following meanings:
(1) “Asset” or “asset test” means, for the purposes of this article, all assets of the members of the applicant’s household, including:
(A) All bank accounts, excluding retirement accounts of members of the household;
(B) All cash, excluding the first $2,000 of members of the household;
(C) All lottery and gambling income of the household, whether received as a lump sum or installment payments;
(D) All real estate, excluding the primary household residence and surrounding lot; and
(E) All other personal property, excluding personal belongings, household goods, and one vehicle.
(2) “Applicant” or “recipient” means a person who is applying for, or currently receiving, public assistance in the State of West Virginia from the department.
(3) “Department” means the West Virginia Department of Health and Human Resources.
(4) “Electronic benefit transfer” or “EBT” means any electronic system which allows the department to issue and track benefits via a magnetically encoded payment card.
(5) “Household” means the same as that term is defined in 7 CFR § 273.1(a) and (b).
(6) “Public assistance” means government benefits provided to qualifying individuals on the basis of need to provide basic necessities to individuals and their families. These shall include, but are not limited to, the following:
(A) Supplemental Nutrition Assistance Program or SNAP;
(B) Medicaid; and
(C) Temporary Assistance to Needy Families or TANF.
(7) “Secretary” means the Secretary of the West Virginia Department of Health and Human Resources.
§9-8-2. Asset test.
(a) For the purposes of determining eligibility for receipt of SNAP benefits, the department shall conduct an asset test on all members of the applicant’s household. The allowable financial resources for eligibility for SNAP shall be those specified in 7 USC § 2014(g)(1).
(b) Prior to determining eligibility for SNAP benefits, the department shall access information for every member of the applicant’s household from, at a minimum, the following federal, state, and miscellaneous sources:
(1) Federal sources:
(A) The Internal Revenue Service for earned and unearned income information;
(B) The United States Social Security Administration for:
(i) Earned income information;
(ii) Death register information;
(iii) Prisoner information or incarceration status;
(iv) Beneficiary records and earnings information maintained in the Beneficiary and Earnings Data Exchange database;
(v) Earnings and pension information maintained in the Beneficiary Earnings Exchange Record System database; and
(vi) Supplemental security income information maintained in the SSI State Data Exchange database; and
(C) The United States Department of Health and Human Services for:
(i) Income and employment information maintained in its National Directory of New Hires database;
(ii) Federal data sources maintained by the Office of Child Support Enforcement; and
(iii) Veterans’ benefits information in coordination with the department and the West Virginia Department of Veterans’ Assistance in the federal Public Assistance Reporting Information System database.
(2) States sources:
(A) Department of Health and Human Resources databases, including, but not limited to:
(i) Bureau for Child Support Enforcement for income and employment information;
(ii) Bureau for Children and Families for child care services information; and
(iii) Enrollment status in other public assistance programs;
(B) West Virginia Division of Labor for:
(i) Employment information;
(ii) Employer weekly, monthly, or quarterly reports of income and unemployment insurance payments; and
(iii) Utility payments information maintained by the state under the Low Income Home Energy Assistance Program;
(C) West Virginia Low Income Assistance Program for emergency utility payment information; and
(D) West Virginia Consolidated Public Retirement Board for earnings and pension information.
(3) Miscellaneous sources:
(i) Any existing real-time database of persons currently receiving benefits in other states, such as the National Accuracy Clearinghouse; and
(ii) Any databases maintained by the West Virginia Lottery Commission.
(c) Prior to determining eligibility, the department shall access information for every member of the applicant’s household from the following public records:
(1) A nationwide public records data source of physical asset ownership. This may include, but is not limited to, real property, automobiles, watercraft, aircraft, and luxury vehicles, or any other vehicle owned by the applicant and recipient of assistance; and
(2) National and local financial institutions in order to locate undisclosed depository accounts or verify account balances of disclosed accounts.
(d) If every member of the household receives supplemental security income, the provisions of this article do not apply.
§9-8-3. Cooperation in child support enforcement.
Any applicant for SNAP
benefits who is greater than six months in arrears in a child support
obligation entered pursuant to the provisions of §48-11-1 et seq. of
this code shall be required to cooperate with the West Virginia Bureau for
Child Support Enforcement as a condition of eligibility as set forth in 7 CFR §
273.11(o) and (p).
§9-8-4. Income and identity verification.
(a) By December 31, 2018, the department shall redesign an existing system or establish a new computerized income, asset, and identity eligibility verification system or contract with a third-party vendor to verify eligibility, eliminate the duplication of assistance, and deter waste, fraud, and abuse in each public assistance program that it administers.
(b) The department may contract with a third-party vendor to develop a system to provide a service or verify income, assets, and identity eligibility of applicants to prevent fraud, misrepresentation, and inadequate documentation when determining eligibility for public assistance. This system or service shall be accessed prior to determining eligibility, periodically between eligibility redeterminations, and during eligibility redeterminations and reviews. The department may contract with a vendor to provide information to facilitate reviews of recipient eligibility conducted by the department.
(c) Nothing in this article precludes the department from continuing to conduct additional eligibility verification processes currently in practice.
§9-8-5. Eligibility verification.
All applications for benefits must be processed through a system as set forth in this article. Complete applications shall be processed within 10 days of receipt or the minimum period required by federal law. Prior to determining eligibility, the department shall access information for every applicant from the following federal, state, and other sources:
(1) Federal sources:
(A) The Internal Revenue Service for earned and unearned income information;
(B) The United States Social Security Administration for:
(i) Earned income information;
(ii) Death register information;
(iii) Prisoner information;
(iv) Beneficiary records and earnings information maintained in the beneficiary and Earnings Data Exchange database;
(v) Earnings and pension information maintained in the Beneficiary Earnings Exchange Record System database; and
(vi) Supplemental security income information maintained in the SSI State Data Exchange database;
(C) The United States Department of Health and Human Services for:
(i) Income and employment information maintained in its National Directory of New Hires database;
(ii) Federal data sources maintained by the Office of Child Support Enforcement; and
(iii) Veterans’ benefits information in coordination with the department and the West Virginia Department of Veterans’ Assistance in the federal Public Assistance Reporting Information System database;
(D) United States Citizenship and Immigration Services for status information;
(E) United States Department of Housing and Urban Development Public Housing and Section 8 Housing Assistance for payment information; and
(F) United States Federal Bureau of Investigation for national fleeing felon information.
(2) States sources:
(A) Department of Health and Human Resources databases, including, but not limited to:
(i) Bureau for Child Support Enforcement for income and employment information;
(ii) Bureau for Children and Families for child care services information;
(B) West Virginia Division of Labor for:
(i) Employment information;
(ii) Employer weekly, monthly, or quarterly reports of income and unemployment insurance payments; and
(iii) Utility payments information maintained by the state under the Low Income Home Energy Assistance Program;
(C) West Virginia Low Income Assistance Program for emergency utility payment information; and
(D) West Virginia Consolidated Public Retirement Board for earnings and pension information.
(3) Other sources:
(i) Any existing real-time database of persons currently receiving benefits in other states, such as the National Accuracy Clearinghouse;
(ii) An available database of persons who currently hold a license, permit, or certificate from any state agency, the cost of which exceeds $500;
(iii) Wage reporting and similar information maintained by states contiguous to West Virginia; and
(iv) A database which is substantially similar to, or a successor of, a database established in this article.
(G) Prior to determining eligibility, the department shall access information for every applicant from, at a minimum, the following public records:
(1) A nationwide public records data source of physical asset ownership. This may include, but is not limited to, real property, automobiles, watercraft, aircraft, and luxury vehicles, or any other vehicle owned by the applicant and recipient of assistance;
(2) A nationwide public records data source of incarcerated individuals;
(3) A nationwide best address and driver’s license data source to verify that individuals are residents of the state;
(4) A comprehensive public records database from which the department can identify potential identity fraud or identity theft that can closely associate name, social security number, date of birth, phone, and address information;
(5) National and local financial institutions in order to locate undisclosed depository accounts or verify account balances of disclosed accounts; and
(6) Outstanding default or arrest warrant information maintained by the Criminal History Systems Board, the Criminal Justice Information System, and the Warrant Management System.
§9-8-6. Identity authentication.
(a) Prior to awarding public assistance, applicants for benefits must complete a computerized identity authentication process to confirm the identity of the applicant. This shall be done with a knowledge-based questionnaire consisting of financial and or personal questions, or both. The questionnaire must provide support for persons without a bank account, or those who have poor access to financial and banking services, or who do not have an established credit history. The questionnaire may be submitted online, in-person or via telephone.
§9-8-7. Case review.
(a) If the information obtained from the review provided in this article does not result in the department finding a discrepancy or change in an applicant’s or recipient’s circumstances affecting eligibility, the department shall take no further action.
(b) If the review results in a discrepancy, the department shall promptly re-determine eligibility.
(c) Public assistance shall not be granted to a household if any member of the household has been found guilty of fraudulent activity directly related to any public assistance program.
(d) Any applicant for public assistance benefits who is greater than six months in arrears in a child support obligation entered pursuant to the provisions of §48-11-1 et seq. of this code is not eligible for public assistance benefits until such time as he or she enters into a payment arrangement with the West Virginia Bureau for Child Support Enforcement or is found by said bureau to have no ability to pay his or her child support obligation.
§9-8-8. Notice and right to be heard.
(a) An applicant shall be given written notice and the opportunity to explain any issues with the application or redetermination as set forth in §9-8-7 of this code. Self-declarations by applicants or recipients shall not be accepted as verification of categorical and financial eligibility during eligibility evaluations, reviews, and redeterminations.
(b) The notice given to the applicant or recipient is required to describe the circumstances of the issue, the manner in which the applicant or recipient may respond, and the consequences of failing to take action. The applicant or recipient shall have 10 days to respond. If the applicant does not respond, the department shall take appropriate action. The department may request additional information as it finds necessary to reach a decision.
(c) If an applicant or recipient responds, he or she shall respond in writing and may:
(1) Disagree with the findings of the department. The department shall reinvestigate the matter if the applicant or recipient disagrees. If the department finds that there has been an error, the department shall take immediate action to correct it. If the department determines that there is no error, the department shall determine the effect on the applicant’s or recipient’s case and take appropriate action. Written notice of the department’s action shall be given to the applicant or recipient; or
(2) Agree with the findings of the department. The department shall determine the effect on the applicant’s or recipient’s case and take appropriate action. Written notice of the department’s action shall be given to the applicant or recipient.
(d) If the applicant fails to respond to the notice, the department shall deny or discontinue assistance for failure to cooperate. The applicant shall be given notice of intent to deny or discontinue assistance. Eligibility for assistance may not be established or reestablished until the issue has been resolved.
§9-8-9. Referrals for fraud, misrepresentation, or inadequate documentation.
(a) After the case review as set forth in §9-8-7 of this code, the department may refer cases of suspected fraud to the office of Inspector General within the department. That office shall take appropriate action, including civil penalties or referral to an appropriate prosecuting attorney for criminal prosecution.
(b) In cases of substantiated fraud, upon conviction, the state shall review all appropriate legal options. These may include, but are not limited to, removal from other public assistance programs and garnishment of wages or state income tax refunds until the department recovers an equal amount of benefits fraudulently claimed.
(c) The department may refer suspected cases of fraud, misrepresentation, or inadequate documentation to appropriate agencies, divisions, or departments for review of eligibility issues in other public assistance programs. This should also include cases in which an individual is determined to be no longer eligible for the original program.
§9-8-10. Reporting to the Governor and Legislature.
The department shall prepare an annual report by December 31 each year to the Governor and Legislative Oversight Commission on Health and Human Resources Accountability. The report shall contain information on the effectiveness and general findings of the eligibility verification system, including the number of cases reviewed, the number of case closures, the number of referrals for criminal prosecution, recovery of improper payment, collection of civil penalties, the outcomes of cases referred to the office of inspector general, and any savings that have resulted from the system.
§9-8-11. Prohibitions on use of electronic benefit transfer cards.
(a) To ensure that public assistance program funds are used for their intended purposes, funds available on electronic benefit transfer cards may not be used to purchase alcohol, liquor or imitation liquor, cigarettes, tobacco products, bail, gambling activities, lottery tickets, tattoos, travel services provided by a travel agent, money transmission to locations abroad, sexually oriented adult materials, concert tickets, professional or collegiate sporting event tickets, or tickets for other entertainment events intended for the general public.
(b) Electronic benefit transfer card transactions are prohibited at all casinos, gaming establishments, tattoo parlors, massage parlors, body piercing parlors, spas, nail salons, lingerie shops, vapor cigarette stores, psychic or fortune-telling businesses, bail bond companies, video arcades, movie theaters, swimming pools, cruise ships, theme parks, dog or horse racing facilities, pari-mutuel facilities, sexually oriented businesses, retail establishments which provide adult-oriented entertainment in which performers disrobe or perform in an unclothed state for entertainment, and businesses or retail establishments where minors under age 18 are not permitted.
(c) Upon enrollment, the department shall provide all applicants with an itemized list of prohibited purchases, including those specified in this section, and make such list available on the department’s website.
(d) If a recipient is found to have violated the provisions of this section, the department shall issue a warning in writing to the recipient. The recipient shall be subject to disqualification of benefits for up to three months following the first offense, for up to one year following the second offense, and a permanent termination of benefits following the third offense, unless expressly prohibited by federal law.
§9-8-12. Tracking out-of-state spending.
(a) The department shall post on its web sites and provide to the Joint Committee on Government and Finance a report of Supplemental Nutrition Assistance Program and Temporary Assistance for Needy Families benefit spending on or before January 15 of each year.
(b) The report required by this section shall include:
(1) The dollar amount and number of transactions of Supplemental Nutrition Assistance Program benefits that are accessed or spent out-of-state, by state;
(2) The dollar amount and number of transactions of Temporary Assistance for Needy Families benefits that are accessed or spent out-of-state, by state;
(3) The dollar amount, number of transactions, and times of transactions of Supplemental Nutrition Assistance Program benefits that are accessed or spent in-state, by retailer, institution, or location; and
(4) The dollar amount, number of transactions, and time of Temporary Assistance for Needy Families transactions of benefits that are accessed or spent in-state, disaggregated by retailer, institution, or location.
(c) The report required pursuant to this section shall not identify individual recipients.
§9-8-13. Rulemaking.
The secretary may promulgate rules for legislative approval in accordance with the provisions of §29A-3-1 et seq. of this code which he or she finds necessary to effectuate the provisions of this article.
Chapter 61. CRIMES AND THEIR PUNISHMENT.
ARTICLE 3. CRIMES AGAINST PROPERTY.
§61-3-54. Taking identity of another person; penalty.
Any person who knowingly
takes the name, birth date, Social Security number, or other identifying
information of another person, without the consent of that other person, with
the intent to fraudulently represent that he or she is the other person for the
purpose of making financial or credit transactions in the other person's name, or
for the purpose of gaining employment, is guilty of a felony and, upon
conviction, shall be punished by confinement imprisonment in the
penitentiary not more than five years, or fined not more than $1,000, or both: Provided,
That the provisions of this section do not apply to any person who obtains
another person's driver’s license or other form of identification for the sole
purpose of misrepresenting his or her age.
NOTE: The purpose of this bill is to prevent fraud and abuse through investigations, inspections, evaluations, and review conducted by the Department of Health and Human Resources; dis-enrolling providers who commit fraud and requiring repayment; defining fraud as it relates to Medicaid; authorizing penalties against providers for failure to keep medical records for a specific time period; authorizing a civil cause of action for fraud when a person or entity knew or should have known a claim to be false; enlarging the statute of limitations to file health care fraud civil actions; defining terms relating to public assistance fraud; providing for an asset test for SNAP benefits which authorizes the access of information of various federal, state and miscellaneous sources; requiring cooperation with the Bureau for Child Support Enforcement; requiring a design or establishment of a computerized income, asset, and identity verification system for each public assistance program administered by the department; allowing for contracting with a third-party vendor; setting out required contract terms; requiring accessing information of various federal, state, and miscellaneous sources for eligibility verification; requiring identity authentication as a condition to receive public assistance; authorizing the department to study the feasibility of requiring photos on EBT cards; prohibiting payment of public assistance benefits in specified instances; setting forth notice requirements and right to a hearing; requiring referrals for fraud, misrepresentation, and inadequate documentation; requiring report to the Governor and Legislature; setting forth prohibitions on the use of an electronic benefit transfer card; tracking out-of-state spending of SNAP and TANF benefits; providing for rulemaking; and providing a penalty for taking the identity of another person for the purpose of gaining employment.
Strike-throughs indicate language that would be stricken from a heading or the present law and underscoring indicates new language that would be added.
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