S.F. 334 Section 1. PUBLIC ASSISTANCE PROGRAMS —— VERIFICATION OF 1 APPLICANT ELIGIBILITY. 2 1. The department of human services shall implement an 3 eligibility verification system for public assistance programs 4 to verify the eligibility of an individual who is an applicant 5 for any such program. The information to be verified and 6 sources to be examined for each individual shall include but 7 are not limited to all of the following: 8 a. Earned and unearned income. 9 b. Employment status and changes in employment. 10 c. Immigration status. 11 d. Residency status, including a nationwide best-address 12 source to verify that individuals are residents of the state. 13 e. Enrollment status in other state-administered public 14 assistance programs. 15 f. Incarceration status. 16 g. Death records. 17 h. Enrollment status in public assistance programs outside 18 of this state. 19 i. Records of any potential identity fraud or identity 20 theft. 21 2. The department of human services shall enter into a 22 memorandum of understanding with any department, division, 23 bureau, section, unit, or any other subunit of a department, as 24 necessary, to obtain the information specified in subsection 1. 25 3. The department may contract with a third-party vendor 26 to provide the information specified in subsection 1. Such 27 contract shall not require the third-party vendor to determine 28 applicant or enrollee eligibility. Any such contract shall 29 include a provision that ensures that annualized savings to 30 the state exceed the contract’s total annual cost to the 31 state, and that the cost of a third-party vendor to provide 32 the information is less than the cost to the department to 33 internally obtain and compile the information. 34 4. Nothing in this section shall preclude the department 35 -1- LSB 1957SV (4) 88 pf/rh 1/ 8

S.F. 334 of human services from receiving, reviewing, or verifying 1 additional information related to the eligibility of an 2 individual not specified in this section or from contracting 3 with a third-party vendor to provide additional information not 4 specified in this section. 5 5. For the purposes of this section, “public assistance 6 program” shall include but is not limited to the Medicaid 7 program, the family investment program (FIP), and the 8 supplemental nutrition assistance program (SNAP). 9 Sec. 2. PUBLIC ASSISTANCE PROGRAMS —— REAL-TIME ELIGIBILITY 10 MONITORING. 11 1. At least quarterly, the department of human services 12 shall obtain and review all of the following information and 13 sources to determine ongoing eligibility of an enrollee in a 14 public assistance program: 15 a. Earned and unearned income. 16 b. Employment status and changes in employment. 17 c. Residency status. 18 d. Enrollment status in other state-administered public 19 assistance programs. 20 e. Financial resources. 21 f. Incarceration status. 22 g. Death records. 23 h. Lottery winnings. 24 i. Enrollment status in public assistance programs outside 25 of the state. 26 2. The department of human services shall enter into a 27 memorandum of understanding with any department, division, 28 bureau, section, unit, or any other subunit of a department to 29 obtain the information specified in subsection 1. 30 3. The department may contract with a third-party vendor 31 to provide the information specified in subsection 1. Such 32 contract shall not require the third-party vendor to determine 33 applicant or enrollee eligibility. Any such contract shall 34 include a provision that ensures that annualized savings to 35 -2- LSB 1957SV (4) 88 pf/rh 2/ 8

S.F. 334 the state exceed the contract’s total annual cost to the 1 state, and that the cost of a third-party vendor to provide 2 the information is less than the cost to the department to 3 internally obtain and compile the information. 4 4. The department shall explore opportunities to join 5 existing multistate collaborations to identify individuals who 6 are also enrolled in public assistance programs outside of the 7 state, including the national accuracy clearinghouse. 8 5. Nothing in this section shall preclude the department 9 of human services from receiving or reviewing additional 10 information related to the eligibility of an individual 11 not specified in this section or from contracting with a 12 third-party vendor to provide additional information not 13 specified in this section. 14 6. If the department receives information about an enrollee 15 in a public assistance program that indicates a potential 16 change or discrepancy in circumstances that may affect the 17 individual’s eligibility for that public assistance program, 18 the department shall review the individual’s circumstances and 19 respond appropriately, as follows: 20 a. If the review does not result in the department 21 confirming any discrepancy or change in an individual’s 22 circumstances that may affect eligibility, the department shall 23 take no further action. 24 b. If the review results in the department finding 25 a potential discrepancy or change in the individual’s 26 circumstances that may affect eligibility, the department shall 27 promptly notify the individual. 28 (1) The department shall provide written notice to the 29 enrollee, which shall describe in sufficient detail the 30 circumstances of the potential discrepancy or change, the 31 manner in which the enrollee may respond, and the consequences 32 of failing to take action. However, a self-declaration of an 33 enrollee alone shall not be accepted as verification to refute 34 the information. 35 -3- LSB 1957SV (4) 88 pf/rh 3/ 8

S.F. 334 (2) The enrollee shall have thirty business days to respond 1 to the department in writing, to provide information to 2 refute and resolve the potential discrepancy or change. After 3 receiving the enrollee’s written response, the department may 4 request additional documentation if the department determines 5 that the documentation is inadequate or that a risk of fraud or 6 misrepresentation exists. A self-declaration of an enrollee 7 refuting the information shall not, alone, constitute a 8 refutation of the potential discrepancy or change. 9 (3) If the enrollee does not respond to the written 10 notice in a timely manner, the department shall provide 11 notice to terminate the individual’s enrollment, based upon 12 the individual’s failure to cooperate, and shall terminate 13 the individual’s enrollment in any applicable public 14 assistance program. The individual’s eligibility shall not be 15 reestablished until the discrepancy or change is resolved. 16 (4) If the enrollee responds to the written notice in a 17 timely manner and disagrees with the findings, the department 18 shall reevaluate the enrollee’s situation. If the department 19 determines through the reevaluation that the information upon 20 which the discrepancy or change was based is in error, the 21 department shall take immediate action to correct the error and 22 no further action on the enrollee’s eligibility status shall be 23 taken. If the department affirms through the reevaluation that 24 a discrepancy or change exists, the department shall determine 25 the effect on the enrollee’s eligibility and take appropriate 26 action. Written notice of the results of the department’s 27 reevaluation and the actions to be taken shall be provided to 28 the individual. 29 (5) If the enrollee responds to the written notice in a 30 timely manner and agrees with the findings, the department 31 shall determine the effect on the enrollee’s circumstances and 32 take appropriate action. Written notice of the actions to be 33 taken by the department shall be provided to the individual. 34 7. For the purposes of this section, “public assistance 35 -4- LSB 1957SV (4) 88 pf/rh 4/ 8

S.F. 334 program” shall include but is not limited to Medicaid, the 1 family investment program (FIP), and the supplemental nutrition 2 assistance program (SNAP). 3 Sec. 3. REPORTING OF FRAUD. If, through the department’s 4 activities under this Act, the department discovers potential 5 fraudulent activity, the department shall report its findings 6 and any supportive information to the department of inspections 7 and appeals for review. 8 Sec. 4. ADMINISTRATION —— REPORTING. 9 1. The department of human services shall adopt rules 10 pursuant to chapter 17A to administer this Act. 11 2. The department shall submit a report to the governor 12 and the general assembly by January 15, 2020, and by January 13 15 annually thereafter, detailing the impact of verification 14 of applicant eligibility for public assistance programs and 15 real-time eligibility monitoring of recipients of public 16 assistance programs as provided in this Act. The initial 17 report shall provide information for the period beginning July 18 1, 2019, and ending December 31, 2019. The reports shall 19 include the number of cases reviewed, the number of cases 20 closed, the number of fraud investigation referrals made, and 21 the amount of savings and cost avoidance realized from the 22 provisions of the Act. 23 3. The department of human services shall submit, to the 24 centers for Medicare and Medicaid services (CMS) of the United 25 States department of health and human services any Medicaid 26 state plan amendment or waiver request necessary to administer 27 this Act. 28 Sec. 5. IMPLEMENTATION. 29 1. The provisions of this Act requiring approval of a 30 Medicaid state plan amendment or waiver shall be implemented 31 upon receipt of such federal approval. 32 2. The provisions of this Act not requiring approval of a 33 Medicaid state plan amendment or waiver shall be implemented 34 on January 1, 2020. 35 -5- LSB 1957SV (4) 88 pf/rh 5/ 8

S.F. 334 EXPLANATION 1 The inclusion of this explanation does not constitute agreement with 2 the explanation’s substance by the members of the general assembly. 3 This bill relates to public assistance program oversight. 4 For purposes of the bill, “public assistance program” includes 5 but is not limited to the Medicaid program, the family 6 investment program, and the supplemental nutrition assistance 7 program. 8 The bill provides for verification of a public assistance 9 program applicant’s eligibility. The department of human 10 services (DHS) is required to implement an eligibility 11 verification system for public assistance programs to verify 12 the eligibility of an individual who is an applicant for 13 any such program. The bill specifies the information to 14 be verified; requires DHS to enter into a memorandum of 15 understanding with any department or subunit of a department, 16 as necessary, to obtain the information specified; and 17 authorizes DHS to contract with a third-party vendor to provide 18 the information specified but not to determine eligibility, 19 subject to provisions in the contract that ensure that 20 annualized savings to the state exceed the contract’s total 21 annual cost to the state and that the cost of the third-party 22 vendor to provide the information is less than the cost to 23 DHS to obtain and compile the information internally. The 24 bill does not preclude DHS from receiving, reviewing, or 25 verifying additional information related to the eligibility of 26 an individual not specified in the bill or from contracting 27 with a third-party vendor to provide additional information not 28 specified in the bill. 29 The bill provides for real-time monitoring of the 30 eligibility of public assistance program enrollees. The 31 bill requires DHS, as least quarterly, to obtain and review 32 specified information to determine ongoing eligibility of an 33 individual enrolled in a public assistance program. The bill 34 requires DHS to enter into memoranda of understanding with any 35 -6- LSB 1957SV (4) 88 pf/rh 6/ 8

S.F. 334 department or subunit of a department, as necessary, to obtain 1 the information specified; authorizes DHS to contract with a 2 third-party vendor to provide the information specified but not 3 to determine eligibility, subject to provisions in the contract 4 that ensures that annualized savings to the state exceed the 5 contract’s total annual cost to the state and that the cost 6 of the third-party vendor to provide the information is less 7 than the cost to DHS to obtain and compile the information 8 internally; and requires DHS to explore opportunities to join 9 existing multistate collaborations to identify individuals who 10 are also enrolled in public assistance programs outside of the 11 state, including the national accuracy clearinghouse. The bill 12 does not preclude DHS from receiving or reviewing additional 13 information related to the eligibility of an individual not 14 specified in the bill or from contracting with a third-party 15 vendor to provide additional information not specified in the 16 bill. 17 The bill provides that if DHS receives information about 18 an individual enrolled in a public assistance program that 19 indicates a potential change or discrepancy in circumstances 20 that may affect the enrollee’s eligibility for that 21 public assistance program, DHS shall review the enrollee’s 22 circumstances and respond appropriately. The bill delineates 23 the appropriate response based upon the response of the 24 enrollee following notice. 25 The bill provides that if, through the department’s 26 activities under the bill, the department discovers potential 27 fraudulent activity, the department shall report its findings 28 and any supportive information to the department of inspections 29 and appeals for review. The bill requires DHS to adopt 30 administrative rules to administer the bill. 31 The bill requires DHS to submit a report to the governor and 32 the general assembly by January 15, 2020, and by January 15 33 annually thereafter, detailing the impact of the provisions of 34 the bill relating to verification of applicant eligibility for 35 -7- LSB 1957SV (4) 88 pf/rh 7/ 8

S.F. 334 public assistance programs and real-time eligibility monitoring 1 of recipients of public assistance programs. The initial 2 report must include information for the period beginning July 3 1, 2019, and ending December 31, 2019. The reports shall 4 include the number of cases reviewed, the number of cases 5 closed, the number of fraud investigation referrals made, and 6 the amount of savings and cost avoidance resulting from the 7 provisions of the bill. 8 The bill requires DHS to submit, to the centers for Medicare 9 and Medicaid services of the United States department of health 10 and human services, any Medicaid state plan amendment or waiver 11 request necessary to administer the bill. 12 A provision of the bill requiring approval of a Medicaid 13 state plan amendment or waiver is to be implemented upon 14 receipt of such federal approval. A provision of the bill not 15 requiring approval of a Medicaid state plan amendment or waiver 16 is to be implemented on January 1, 2020. 17 -8- LSB 1957SV (4) 88 pf/rh 8/ 8