Proyectos de ley › 89.ª Asamblea General
Relating to recovery of an overpayment to a provider based on specified grounds under the Medicaid program
Presentado por el comité Human Resources de la Cámara
Temas:Health careFamilies & human servicesMedicaid
La misma legislación: HSB 225
Dónde está ahora
- Hecho: Presentado17 de febrero de 2021
- Hecho: Subcomité17 de febrero de 2021
- Hecho: Comité de la Cámara2 de marzo de 2021
- Hecho: Lo aprueba la Cámara24 de marzo de 202197–0
- Hecho: Comité del Senado16 de marzo de 2022
- Hecho: Lo aprueba el Senado29 de marzo de 202247–0
- Hecho: A gobernador(a)17 de mayo de 2022
- Hecho: Firmado como ley17 de mayo de 2022
Firmado como ley ¿Qué es el embudo (funnel)?
Qué contiene
Resumen con IA 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. (Todavía no está traducido al español.)1
Lea la explicación oficial (en inglés)
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.
Cambiado después por las enmiendas S-5095, H-1235; vea Enmiendas.
Texto completo del proyecto (en inglés) · Qué cambió antes de aprobarse2
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
Nota fiscal
Cost: up to $909,000 Compare con otros proyectos
Resumen con IA 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. (en inglés)3
Lea la nota fiscal (en inglés)
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
Cómo cambió el cálculo
- $20,600 9 de marzo de 2021
- $20,600 26 de marzo de 2021
- $909,000 29 de marzo de 2022
- $909,000 27 de junio de 2022 · final
- Final Fiscal Note — Medicaid, Refunds and Offsets · 27 de junio de 2022 · $909,000
- Medicaid, Refunds and Offsets · 29 de marzo de 2022 · $909,000
- Medicaid, Refunds and Offsets · 26 de marzo de 2021 · $20,600
- Medicaid, Refunds and Offsets · 9 de marzo de 2021 · $20,600
Cabildeo
29 a favor · 3 en contra · 15 indecisos · Quiénes →
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Study bill
89th General Assembly
Picked up later
Earlier and later bills are matched by wording or an identical title.