I.The department shall enter into a contract with a vendor to identify, investigate, and resolve potential cases of fraud, misrepresentation, or inadequate documentation prior to determining an applicant's eligibility for assistance under this chapter and RSA 161. The procedures shall ensure that every case is reviewed. Each review shall include utilization of the income and identity verification system established under this section.
II.Payment to the vendor for services provided in this section shall be contingent upon annualized savings realized from implementation of the program, as agreed upon by the commissioner and the vendor.
III.The department shall contract with a vendor to establish a computerized income and identity eligibility verification system in order to verify eligibil
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I. The department shall enter into a contract with a vendor to identify, investigate, and resolve potential cases of fraud, misrepresentation, or inadequate documentation prior to determining an applicant's eligibility for assistance under this chapter and RSA 161. The procedures shall ensure that every case is reviewed. Each review shall include utilization of the income and identity verification system established under this section.
II. Payment to the vendor for services provided in this section shall be contingent upon annualized savings realized from implementation of the program, as agreed upon by the commissioner and the vendor.
III. The department shall contract with a vendor to establish a computerized income and identity eligibility verification system in order to verify eligibility, eliminate duplication of assistance, and deter fraud.
IV. Prior to awarding or continuing assistance under this chapter or RSA 161, the department may contract with a vendor, to the extent such databases are available, to match the name, date of birth, and social security number of each applicant and recipient against the following:
(a) Employer quarterly reports of income and unemployment insurance payment information maintained by the department of employment security.
(b) Earned income information maintained by the Social Security Administration.
(c) Immigration status information maintained by the United States Citizenship and Immigration Services.
(d) Death register information maintained by the Social Security Administration.
(e) Prisoner information maintained by the Social Security Administration.
(f) Public housing and Section 8 housing assistance payment information maintained by the Department of Housing and Urban Development.
(g) National fleeing felon information maintained by the Federal Bureau of Investigation.
(h) Wage reporting and similar information maintained by states contiguous to this state.
(i) Beneficiary records and earnings information maintained by the Social Security Administration in its Beneficiary and Earnings Data Exchange (BENDEX) database.
(j) Earnings and pension information maintained by the Social Security Administration in its Beneficiary Earnings Exchange Record System (BEERS) database.
(k) Employment information maintained by the department of employment security in its new hire directory database.
(l) Employment information maintained by the United States Department of Health and Human Services in its National Directory of New Hires database.
(m) Supplemental Security Income information maintained by the Social Security Administration in its State Data Exchange (SDX) database.
(n) Veterans' benefits information maintained by the United States Department of Health and Human Services, in coordination with the department of health and human services and the Department of Veterans Affairs, in the federal Public Assistance Reporting Information System (PARIS) database.
(o) Child care services information maintained by the department of health and human services under its child care assistance program.
(p) Utility payments information maintained by the department of energy under the fuel assistance program.
(q) A database which is substantially similar to or a successor of a database established in this section.
(r) A database of all persons who currently hold a license, permit, or certificate from a state agency.
V. Prior to awarding or continuing assistance under this chapter or RSA 161, the department shall match the name, date of birth, and social security number of each applicant and recipient against the following public records:
(a) A nationwide public records data source of physical asset ownership such as real property, automobiles, watercraft, aircraft, and luxury vehicles.
(b) A nationwide public records data source of incarcerated individuals.
(c) A comprehensive public records database that identifies potential identity fraud or identity theft that can closely associate name, social security number, date of birth, phone, and address information.
VI. If a discrepancy results between an applicant's or recipient's social security number and one or more of the databases or information tools listed under paragraph IV or V, the department shall review the applicant's or recipient's case using the following procedures:
(a) If the information discovered under paragraph IV and V does not result in the department finding the applicant or recipient ineligible for assistance under this section, the department shall take no further action.
(b) If the information discovered results in the department finding the applicant or recipient ineligible for assistance, the applicant or recipient shall be given an opportunity to explain the discrepancy. The department shall provide written notice to the applicant or recipient which shall describe in sufficient detail the circumstances of the discrepancy, the manner in which the applicant or recipient may respond, and the consequences of failing to take action. The applicant or recipient shall have 10 business days to respond in an attempt to resolve the discrepancy. The explanation provided by the recipient or applicant shall be given in writing. After receiving the explanation, the department may request additional documentation if it determines that there is a substantial risk of fraud.
(c) If the applicant or recipient does not respond to the notice, the department shall deny assistance for failure to cooperate, in which case the department shall provide notice of intent to discontinue assistance. Eligibility for assistance shall not be reestablished until the discrepancy has been resolved.
(d) If an applicant or recipient responds to the notice and disagrees with the findings of the match between his or her social security number and one or more databases or information tools listed under this section, the department shall reinvestigate the matter. If the department finds that there has been an error, the department shall take immediate action to correct it and no further action shall be taken. If, after an investigation, the department determines that there is no error, the department shall determine the effect on the applicant's or recipient's case and take appropriate action. Written notice of the department's action shall be given to the applicant or recipient.
(e) If the applicant or recipient agrees with the findings of the match between the applicant's or recipient's social security number and one or more databases or information tools listed under this section, the department shall determine the effect on the applicant's or recipient's case and take appropriate action. Written notice of the department's action shall be given to the applicant or recipient. In no case shall the department discontinue medical assistance coverage as a result of a match between the applicant's or recipient's social security number and one more databases or information tools listed under this section until the applicant or recipient has been given notice of the discrepancy and the opportunity to respond.
(f) The applicant or recipient shall have an opportunity for a fair hearing in the event of any adverse action affecting eligibility for assistance under this chapter or RSA 161.
VII. The department may contract with third party entities to perform the review of such enrollees as authorized under this section or to provide information to facilitate such reviews.
VIII. The department shall, pursuant to RSA 541-A, adopt any rules necessary to implement this section.