Bills › 89th General Assembly
Relating to recovery of an overpayment to a provider based on specified grounds under the Medicaid program
Sponsored by the House Human Resources Committee
Topics:Health careFamilies & human servicesMedicaid
Same legislation: HSB 225
Where it is now
- Done: IntroducedFebruary 17, 2021
- Done: SubcommitteeFebruary 17, 2021
- Done: House committeeMarch 2, 2021
- Done: Passes the HouseMarch 24, 202197–0
- Done: Senate committeeMarch 16, 2022
- Done: Passes the SenateMarch 29, 202247–0
- Done: To the GovernorMay 17, 2022
- Done: Signed into lawMay 17, 2022
Signed into law What’s a funnel?
What’s in it
AI summary State officials can only review Medicaid claims for mistakes if the payment happened within a certain number of months. If a review finds an overpayment after that time has passed, the provider does not have to pay the money back or have it taken from future payments. Providers can still fix any improper payments they find by submitting a claim adjustment.1
Read the official explanation
This bill relates to the limitations on activities related to paid claims under the Medicaid program. The bill provides that notwithstanding any provision of law to the contrary, any post-payment review of Medicaid provider claims paid under either Medicaid fee-for-service or managed care administration that do not involve fraud or misrepresentation shall be limited to a review of only those claims for which no more than months have elapsed since the date of payment of the claim. Additionally, any provider overpayment identified for which months or more have elapsed since the date of payment of the claim shall not be subject to repayment or to offset against future reimbursement of claims by the provider. Any improper payment identified through a review may be resubmitted by the provider as a claims adjustment. The bill take effect upon enactment.
Changed since by amendments S-5095, H-1235; see Amendments.
Senate subcommittee
Named March 11, 2022. On March 14, 2022 it recommended passage.
Three legislators hear a bill first and recommend what the committee should do; it’s the best time to weigh in. How to take part
Fiscal note
Cost: up to $909,000 Compare with other bills
AI summary This bill requires the Department of Human Services to use state funds to reimburse Medicaid providers if a recipient is later found to be ineligible after care was already delivered. The change is estimated to cost the state $909,000 in fiscal year 2023 and subsequent fiscal years.3
Read the fiscal note
Description
House File 736 specifies that if a recipient is deemed ineligible for Medicaid following the delivery of care or service by a provider, in an administrative action to recover overpayment to the provider based solely on the ground of ineligibility, the Department of Human Services (DHS) is required to reimburse the provider for any recoupment or overpayment using State funds only. To be eligible to receive the State payment, the provider must have verified eligibility and obtained any necessary prior authorizations for the recipient, documented those actions in a manner or format established by DHS rule, and retained the required documentation in the recipient’s file.
Assumptions
This change will mainly impact individuals who were incarcerated, and the estimated fiscal impact is based on incarceration recoveries. No federal matching Medicaid funds will be used to reimburse providers.
Fiscal Impact
House File 736 is estimated to cost the State $909,000 in FY 2023 and subsequent fiscal years.
Source
- Department of Human Services
How the estimate changed
4- Final Fiscal Note — Medicaid, Refunds and Offsets · June 27, 2022 · $909,000
- Medicaid, Refunds and Offsets · March 29, 2022 · $909,000
- Medicaid, Refunds and Offsets · March 26, 2021 · $20,600
- Medicaid, Refunds and Offsets · March 9, 2021 · $20,600
Lobbying
29 for · 3 against · 15 undecided · Who →
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89th General Assembly
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Earlier and later bills are matched by wording or an identical title.
Similar bills
- HSB 501 HSB 50190th General Assembly · Renumbered as HF 2268Nearly identical
- HF 2142 Relating to limitations on activities related to paid claims under the Medicaid program, a…91st General Assembly · In committeeNearly identical
Matched by wording or an identical title.