Mississippi Code 1972 (2023) › Title 43 - PUBLIC WELFARE (§§ 43-1-1 — 43-NEW01-012) › Chapter 12 - MEDICAID AND HUMAN SERVICES TRANSPARENCY AND FRAUD PREVENTION ACT (§§ 43-12-1 — 43-12-71) › MEDICAID AND HUMAN SERVICES TRANSPARENCY AND FRAUD PREVENTION (§§ 43-12-1 — 43-12-47) › Section 43-12-5 - Real-time eligibility verification service

(1)
Definitions. For purposes of Sections
43-12-5
through
43-12-17
, the following definitions apply:
(a)
"Department" means the Division of Medicaid or the Department of Human Services, as the case may be.
(b)
"Identity information" means an applicant or recipient's full name, aliases, date of birth, address, Social Security number and other related information, including, but not limited to, the information in subsection (2)(a) of this section.
(2)
Establishment of enhanced eligibility verification service.
(a)
The department shall establish and use a computerized income, asset, residence and identity eligibility verification service in order to verify eligibility, eliminate the duplication of assistance, and deter waste, fraud, and abuse within each respective assistance program administered by the department. The information verified shall include, but not be limited to:
(i)
Earned and unearned income;
(ii)
Employment status and changes in employment;
(iii)
Immigration status;
(iv)
Residency status, including a nationwide best-address source to verify individuals are residents of the state;
(v)
Enrollment status in other state-administered public assistance programs, as available in a cost-efficient manner;
(vi)
Financial resources;
(vii)
Incarceration status;
(viii)
Death records;
(ix)
Enrollment status in public assistance programs outside of this state, as available in a cost-efficient manner; and
(x)
Potential identity fraud or identity theft.
(b)
The department may issue a Request for Proposals (RFP) from multiple third-party vendors, regardless of the amount of funds to be expended under the contract, for the purposes of identifying fraud in the programs described in this chapter and pursuant to the specifications prescribed in this subsection (2). After evaluating the proposals submitted, the department shall enter into a competitively bid contract with a third-party vendor for the purposes of using and accessing an eligibility verification service by which to verify the income, assets, residence, identity, and other information in paragraph (a) of this subsection (2) to prevent fraud, misrepresentation, and inadequate documentation when determining an applicant's eligibility for assistance before the distribution of benefits, periodically between eligibility redeterminations, and during eligibility redeterminations and reviews, as prescribed in this section. The department may use more than one (1) eligibility verification service and/or third-party vendor, if doing so is more cost-efficient. The department may renegotiate an existing contract with a current vendor for the purposes stated in this paragraph (b) if doing so is more cost-efficient than issuing a Request for Proposals (RFP) from multiple third-party vendors. If the department determines that it is not more cost-efficient to renegotiate an existing contract with a current vendor, the department shall issue a Request for Proposals (RFP) from multiple third-party vendors as provided in this paragraph (b), regardless of the amount of funds to be expended under the contract. The department may also enter into a competitively bid contract with a third-party vendor to provide information to facilitate reviews of recipient eligibility conducted by the department.
(c)
When the department enters into a competitively bid contract with a third-party vendor or renegotiates an existing contract with a current vendor for the purposes of carrying out this eligibility verification service, the vendor, in partnership with the department, shall be required by contract to establish annualized savings realized from implementation of the eligibility verification service. It is the intent of the Legislature that savings exceed the total yearly cost for implementing the eligibility verification service.
(d)
To avoid any conflict of interest, when the department enters into a competitively bid contract with a third-party vendor or renegotiates an existing contract with a current vendor, that primary vendor may not currently or will not be allowed to bid on or be awarded a state contract to run enrollment services.
(e)
It shall be the responsibility of the contracted third-party vendor to obtain access to any data, data sources and databases, not already being used by the department, for the purposes of implementing the eligibility verification service. The payment structure for the contracted third-party vendor shall be based on a per-applicant rate.
(f)
Nothing in this section shall preclude the department from continuing to conduct additional eligibility verification processes, not detailed in this section, that are currently in practice; and nothing in this section shall require the department or third-party vendor to violate the Fair Credit Reporting Act.
(3)
The department shall have the eligibility verification service required by this section implemented and operational not later than July 1, 2019. The department shall submit a report every six (6) months on its progress on implementing the eligibility verification service 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. The report also shall be provided to the other members of the Legislature upon request.
(4)
(a)
As used in this subsection, the following terms shall be defined as provided in this paragraph:
(i)
"Abuse" includes any practice that is inconsistent with acceptable fiscal, business or medical practices that unnecessarily increase cost.
(ii)
"Fraud" means misrepresenting the truth to obtain an unauthorized benefit.
(b)
The department shall enter or have entered into a competitively-bid contract with a third-party vendor for the purposes of identifying waste, abuse and fraud in the programs administered by the department, focusing on detecting and preventing abuse and fraud by providers of services in those programs, and recovering improper payments made to providers of services in those programs.
Added by Laws, 2017, ch. 421, HB 1090, 3, eff. 7/1/2017.