§ 43-12-1. Short title
This chapter shall be known and may be cited as the “Medicaid and Human Services Transparency and Fraud Prevention Act.”
§ 43-12-11. Discrepancies and case review
If a discrepancy results from an applicant or recipient’s identity information and one or more of the databases or information tools authorized under Sections 43-12-5 through 43-12-17, the department shall review the respective applicant or recipient’s case using the following procedures: If the information discovered does not result in the department finding a discrepancy or […]
§ 43-12-13. Referrals for fraud, misrepresentation, or inadequate documentation
After reviewing changes or discrepancies that may affect program eligibility, the department shall refer, within forty-five (45) business days, suspected cases of fraud, misrepresentation, or inadequate documentation to appropriate agencies, divisions, or departments for review of eligibility discrepancies in other public programs. This shall also include cases where an individual is determined to be no […]
§ 43-12-15. Reporting
Thirty (30) business days before entering into a competitively bid contract for the eligibility verification service required by Section 43-12-5, the department shall provide a written report to the Governor, the Chairmen of the House and Senate Appropriations Committees, the House Public Health and Human Services Committee and the Senate Public Health and Welfare Committee, […]
§ 43-12-17. Transparency in Medicaid
Following the precedent set by Medicare, the department shall electronically release to the public data that includes, but is not limited to the following: the provider’s name and office locations; a provider’s National Provider Identifier (NPI); the type of service provided by Healthcare Common Procedure Coding System (HCPCS) code; and whether the service was performed […]
§ 43-12-19. Work requirements
The Department of Human Services shall not seek, apply for, accept or renew any waiver of requirements established under 7 USC Section 2015(o), except during a formal state or federal declaration of a natural disaster.
§ 43-12-21. Federal asset limits for the Supplemental Nutrition Assistance Program
In no case shall the resource limit standards of the Supplemental Nutrition Assistance Program (SNAP) exceed the standards specified in 7 USC Section 2014(g)(1), unless expressly required by federal law. In no case shall categorical eligibility exempting households from these resource limits be granted for any noncash, in-kind or other benefit, unless expressly required by […]
§ 43-12-23. Broad-based categorical eligibility
In no case shall categorical eligibility under 7 USC Section 2014(a) or 7 CFR Section 273.2(j)(2)(iii) be granted for any noncash, in-kind or other benefit unless expressly required by federal law for the Supplemental Nutrition Assistance Program (SNAP). The Department of Human Services shall not apply gross income standards for food assistance higher than the […]
§ 43-12-25. Sharing enrollee information across agencies
The Division of Medicaid and the Department of Human Services shall share eligibility information with each other within thirty (30) business days when an enrollee has been disenrolled for any financial or nonfinancial reason that may result in the enrollee’s disqualification for benefits with the other department, and shall include the rationale for the action. […]
§ 43-12-27. Maximum family grant
For purposes of determining the maximum aid payment under the TANF program, the number of persons in a household shall not be increased for any child born into a household that has received aid under TANF continuously for the ten (10) months before the birth of the child.
§ 43-12-29. Verify identities and household composition, and all expenses of welfare applicants
The Department of Human Services shall verify identity, household composition, expenses, and any other factor affecting eligibility allowed under 7 CFR Section 273.2(f)(3).
§ 43-12-3. Integration of eligibility systems
The Division of Medicaid shall submit a final Advanced Planning Document to the Centers for Medicare and Medicaid Services (CMS) for the purpose of applying for the OMB A87 exception to support the integration of eligibility systems between the division and any applicable Department of Human Services program where an integrated system of eligibility will […]
§ 43-12-31. Full cooperation with fraud investigations
The Department of Human Services shall communicate the expectation of mandatory cooperation with a fraud investigation and that noncompliance could result in case closure and termination of benefits within thirty (30) business days.
§ 43-12-33. Gaps in eligibility reporting
The Department of Human Services shall not establish or use a simplified reporting system under 7 CFR Section 273.12(a)(5). The department shall provide a written report to the Chairmen of the House and Senate Appropriations Committees, the House Public Health and Human Services Committee and the Senate Public Health and Welfare Committee, and the House […]
§ 43-12-35. Noncompliance with Temporary Assistance for Needy Families program rules
The Department of Human Services shall only grant benefits when an approved applicant has signed a written agreement clearly enumerating continued eligibility requirements, circumstances in which sanctions may be imposed, and any potential penalties for noncompliance. The department shall require all enrollees to be compliant with all program requirements, including work requirements, before granting benefits. […]
§ 43-12-37. Noncompliance with Supplemental Nutrition Assistance Program rules
The Department of Human Services shall set disqualification periods for all instances of noncompliance with any SNAP requirement, unless expressly prohibited by federal law. The department shall institute a three-month, full-household disqualification period for the first instance of noncompliance, unless expressly prohibited by federal law. The department shall institute a six-month, full-household disqualification period for […]
§ 43-12-39. Out-of-state spending
The Department of Human Services shall post on its website and make available on an annual basis to the chairmen of the House and Senate Appropriations Committees, the House Public Health and Human Services Committee and the Senate Public Health and Welfare Committee a report of SNAP and TANF benefit spending. The report also shall […]
§ 43-12-41. Public reporting
The Division of Medicaid and the Department of Human Services shall provide on an annual basis to the chairmen of the House and Senate Appropriations Committees, the House Public Health and Human Services Committee and the Senate Public Health and Welfare Committee, and the House and Senate Medicaid Committees, a report of characteristics of recipients […]
§ 43-12-43. Pilot program for photos on EBT cards
The Department of Human Services may establish a pilot program in which a photograph of the recipient is included on any electronic benefits transfer card issued by the department to the recipient, unless the recipient declines to have the photograph included. When a recipient is a minor or otherwise incapacitated individual, a parent or legal […]
§ 43-12-45. Limits on spending locations
Funds available on electronic benefit transfer cards shall 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 […]