Amendment S-5064 to HF 736

Filed March 16, 2022 in the Senate by

What it changes

1. By striking everything after the enacting clause and inserting: “Section
2. NEW SECTION . 249A.42A Overpayment —— subsequent ineligibility of recipient —— commencement of action and recovery.
3. Notwithstanding any provision to the contrary, if a recipient is deemed ineligible for medical assistance following delivery of care or service by a provider, any administrative action to recover an overpayment to a provider based solely on such recipient’s ineligibility shall be commenced within one year of the date the overpayment was incurred.
4. In an administrative action to recover an overpayment brought on the grounds specified in subsection 1, the department acting as the state Medicaid agency shall reimburse the provider for any recoupment of an overpayment using state-only funds for care or services delivered if all of the following conditions are met: a. The provider verified eligibility through the eligibility and verification system or the secure web portal of, and obtained any necessary prior authorization for, the recipient on whose behalf payment was made to the provider prior to the delivery of care or service to the recipient. b. The provider documented the eligibility verification performed and any necessary prior authorization obtained pursuant to paragraph “a” in a manner and format established by the department by rule, and retained the required documentation in the recipient’s file.
5. The one-year limitation period prescribed under this section does not apply to recovery of an overpayment to a provider in an administrative action brought on other grounds.
6. For the purposes of this section, “incurred” means the same as defined in section 249A.42.”
7. Title page, by striking lines 1 through 3 and inserting “An Act relating to recovery of an overpayment to a provider based on specified grounds under the Medicaid program.”

Official amendment (PDF) · In the Bill Book