Relating to the validation of Medicaid managed care organization encounter data, providing an appropriation, and providing an effective date

This bill requires the department of human services (DHS) and the auditor of state (auditor) to jointly design and issue a request for proposals (RFP) for the performance of a third-party audit to validate encounter data collected and reported by Medicaid managed care organizations (MCOs) to DHS. The audit shall be designed to determine if the MCOs are providing encounter data that, at a minimum, is complete, accurate, consistent, and timely and that complies with federal and contractual requirements related to the collection and reporting of encounter data. The audit shall also be designed to determine whether the type and quality of the encounter data collected, at a minimum, strengthens the state’s capacity for federal compliance and for managed care program oversight and program integrity; for quality measurement, monitoring, and reporting; for capitation rate setting; and for policymaking and decision support. DHS and the auditor shall jointly evaluate third-party proposals received, select and contract with the third-party auditor by July 1, 2022, and monitor and review the third-party auditor’s audit and report which shall be submitted jointly to DHS and the auditor no later than December 15, 2022. The bill appropriates $250,000 from the general fund of the state to DHS and the auditor for the RFP process and the resulting third-party audit as provided in the bill. A portion of the moneys appropriated may be used by DHS and the auditor for administrative expenses related to the RFP process and the audit. DHS shall seek and obtain any Medicaid matching funds available to defray the costs of the RFP and audit. The bill takes effect upon enactment.