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AI Summary
This bill aims to enhance the integrity of Medicaid and CHIP programs by mandating state implementation of technology solutions to prevent and recover from waste, fraud, and abuse.
Business Impact
If you operate in Medicaid or CHIP services in West Virginia, you must implement new technology solutions for fraud prevention by July 1, 2012, or risk financial losses.
What do these statuses mean? ▼
Introduced
— Filed in the legislature; not yet heard in committee
In Committee
— Assigned to and being reviewed by a legislative committee
Passed
— Approved by one or both chambers; awaiting further action
Signed / Enacted
— Signed into law by the governor; may or may not be in effect yet
Dead / Vetoed
— Vetoed, failed to pass, or session expired without action
Unknown
— Status data not yet available or awaiting classification
Affected Industries
Topics How we classify →
What This Means
Senate Bill 195 seeks to bolster the integrity of West Virginia's Medicaid and Children's Health Insurance Program through advanced technology solutions. It mandates the state to implement data verification, predictive analytics, and fraud detection services, focusing on contractor selection.
Key Provisions
- Implementation of provider data verification and screening technology solutions.
- Use of state-of-the-art predictive modeling and analytics technologies.
- Mandatory reporting by the Secretary of Health and Human Services and the Director of CHIP.
- Contractor selection process using the Cooperative Purchasing Network.
- Implementation of fraud investigative services combining retrospective and prospective techniques.
- Audit and recovery services for Medicaid and CHIP claims.
Latest Legislative Action
To Judiciary
Bill Sponsors
| Name | Role |
|---|---|
| Weld | Primary |
| Phillips | Cosponsor |
Compliance Checklist
Implement provider data verification and screening technology solutions.
Who: State Medicaid and CHIP programs.
Deadline: By July 1, 2012.
Penalty: Potential financial losses due to improper payments.
Who: State Medicaid and CHIP programs.
Deadline: By July 1, 2012.
Penalty: Potential financial losses due to improper payments.
Submit required reports on technology implementation and savings.
Who: Secretary of Health and Human Services and Director of CHIP.
Deadline: Within three months after each implementation year.
Penalty: Lack of transparency and accountability.
Who: Secretary of Health and Human Services and Director of CHIP.
Deadline: Within three months after each implementation year.
Penalty: Lack of transparency and accountability.
Full Legal Analysis
Senate Bill 195 introduces a comprehensive framework aimed at improving the integrity of Medicaid and the Children's Health Insurance Program in West Virginia. It mandates the implementation of various technology solutions, including data verification, predictive modeling, and fraud investigative services, to detect and prevent waste, fraud, and abuse. Compliance is required from state Medicaid and CHIP programs, with a focus on transitioning from a retrospective to a prospective payment model. The bill outlines a contractor selection process, emphasizing the need for entities to demonstrate technical and analytical capabilities. This bill aligns with federal program integrity provisions, specifically complying with the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010, indicating a broader trend towards leveraging technology in healthcare program management.
Official Source
Official Bill Text
View SB195 on official legislature website →
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