Requiring the availability of certain standardized data analytic technologies under Medicaid

Section 1903 of the Social Security Act (42 U.S.C. 1396b) is amended by adding at the end the following new subsection: (cc) Availability of standardized data analytic technologies To identify fraud (1) In general Beginning not later than 180 days after the date of the enactment of this subsection, the Secretary shall make available to each State standardized data analytic technologies for purposes of identifying and preventing fraud, waste, and abuse under the State plan (or waiver of such plan) of such State under this title. In making such technologies available, the Secretary shall— (A) ensure that such technologies are interoperable with the mechanized claims processing and information retrieval systems described in subsection (a)(3)(A)(i), including Medicaid Management Information Systems and State eligibility and enrollment systems, and any other systems relevant to program integrity under this title, as determined by the Secretary; (B) ensure that each State has the ability, through the use of such technologies, to— (i) review the risk indicators described in subparagraph (C)(i) and receive alerts regarding fraud, waste, and abuse vulnerabilities; (ii) access datasets and analytic outputs for purposes of identifying potentially improper billing, utilization, or enrollment patterns; (iii) use any dashboard or other investigative tools made available by the Secretary for the purposes of program integrity under this title; (iv) receive any program integrity alerts that apply across more than 1 State or program; (v) conduct State-specific analyses and generate State-level reports; and (vi) integrate analytic outputs from such technologies into existing State program integrity activities; and (C) use such technologies to— (i) establish risk indicators that reflect the extent to which providers, suppliers, and other entities participating in more than 1 State plan under this title (or waiver of such plan), or participating in multiple Federal health care programs, may present a risk for fraud, waste, or abuse, based on— (I) billing data; (II) utilization data; (III) enrollment data; and (IV) any other relevant data related to a Federal health care program (as determined by the Secretary); and (ii) provide States with actionable alerts based on such risk indicators. (2) Technical assistance The Secretary shall provide technical assistance and training to States on how to use the technologies made available under paragraph (1). (3) Report Not later than 1 year after the date of enactment of this subsection, and annually thereafter, the Secretary shall submit to Congress a report on the technologies described in paragraph (1). Each such report shall include the following information: (A) The number of States with access to the technologies made available under paragraph (1), and a description of any barriers to such access. (B) The rate of utilization of such technologies by each State, and a description of any barriers to such utilization. (C) The number of instances of possible fraud, waste, and abuse identified through the use of such technologies, and an estimate of the amount of overpayments identified and collected in connection with such instances..