Summary

1/4/2013--Introduced.Medicaid Integrity Act of 2013 - Amends title XIX (Medicaid) of the Social Security Act with respect to a state's option to use Medicaid managed care organizations and... Read More

Status

This bill was introduced on Jan 4, 2013, in a previous session of Congress, but was not passed.

Date Introduced
Jan 4, 2013

Co-Sponsors

Bill Text

A BILL

To amend section 1932 of the Social Security Act to require independent audits and actuarial services under Medicaid managed care programs, and for other purposes.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the ``Medicaid Integrity Act of 2013''.

SEC. 2. INDEPENDENT AUDIT AND ACTUARY REQUIREMENTS FOR STATE MEDICAID MANAGED CARE PROGRAMS.

(a) In General.--Section 1932 of the Social Security Act (42 U.S.C. 1396u-2) is amended by adding at the end the following: ``(i) Independent Audit Requirements.-- ``(1) In general.--As a condition of receiving a payment under section 1903(a) with respect to expenditures under a contract with a managed care entity under section 1903(m), a State, acting through the State agency under the State plan or another State entity, shall, in accordance with this subsection, enter into a contract with an independent auditor to-- ``(A) conduct audits of such managed care entity under such contract; and ``(B) report the results of such audits under paragraph (7). ``(2) Independent auditor defined.--In this subsection, subject to subparagraph (B), the term `independent auditor' means, with respect to the audit of a managed care entity in a State for a period of time, an auditing entity that-- ``(A) had no financial relationship with the managed care entity or an affiliate of such managed care entity for activities occurring during the period for which the audit is conducted; ``(B) has no such financial...

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State: CA

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Bill Summary

1/4/2013--Introduced.Medicaid Integrity Act of 2013 - Amends title XIX (Medicaid) of the Social Security Act with respect to a state's option to use Medicaid managed care organizations and primary care case managers. Requires a state, acting through the state medical assistance agency or another state entity, in order to receive federal medical assistance percentage (FMAP) payments for expenditures under a contract with a managed care entity, to contract with an independent auditor to conduct biannual financial and performance-compliance audits of the entity. Directs the Secretary of Health and Human Services (HHS) to set uniform audit standards according to specified requirements. Requires the state to document for the Secretary its response to deficiencies reported in such audits. Requires contracts between the state and managed care entities to require the managed care entity to give the independent auditor access to all necessary information. Establishes sanctions for misrepresentation or falsification of information. Prescribes requirements a state must meet to be allowed to enter into an agreement with an actuary with respect to the state's administration of a contract with a managed care entity.

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