Bills › 90th General Assembly
Relating to limitations on activities related to paid claims under the Medicaid program, and including effective date provisions
Sponsored by the House Health and Human Services Committee
Topics:Health careFamilies & human servicesMedicaid
Same legislation: HSB 501
Where it is now
- Done: IntroducedJanuary 8, 2024
- Done: SubcommitteeJanuary 8, 2024
- Done: House committeeJanuary 30, 2024
- Stopped: Passes the HouseDied when the General Assembly ended
- Next: Senate committee
- Next: Passes the Senate
- Next: To the Governor
- Next: Signed into law
Died when the session ended The 2024 session adjourned on April 19, 2024, the General Assembly’s last regular session. Bills that didn’t pass both chambers died. What’s a funnel?
What’s in it
AI summary Under this law, the state can only review Medicaid claims for mistakes if the payment happened within a certain number of months. If a review finds that a provider was paid too much 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 mistakes 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 takes effect upon enactment.
House subcommittee
Named January 8, 2024 (as HSB 501). On January 16, 2024 it recommended passage. Vote Total: 3-0.
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 $535,000 Compare with other bills
AI summary This bill limits the time the state can review Medicaid claims and recover overpayments from providers to 24 months unless fraud is involved. It is estimated to increase costs to the State Medicaid program by approximately $535,000 annually beginning in fiscal year 2025. These increased costs would come from the General Fund Medical Assistance appropriation.3
Read the fiscal note
Description
House File 2268 limits any post-payment review of claims paid under either Medicaid fee-for-service (FFS) or managed care administration to 24 months from the date of payment unless the claim involves fraud or misrepresentation. In addition, any provider overpayment identified for which 24 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, and any improper payment identified through a review may be resubmitted by the provider as a claims adjustment. The Bill does not apply to retroactive Medicaid cost settlements or rate changes based on a Medicaid or Medicare cost report.
The Bill takes effect upon enactment.
Background
Iowa Code section 249A.42 allows an administrative action to recover a provider overpayment within a period of five years from the date an overpayment was incurred, which would be changed in the Bill to 24 months for instances of overpayment that do not involve fraud or misrepresentation.
Assumptions
- The Department of Health and Human Services (HHS) will be required to return the federal share of overpayments to the federal government regardless of collection of overpayments from providers.
- Managed care organizations (MCOs) will make administrative efforts for any recoveries within the 24-month window in the Bill, if enacted, and the Bill will not cause an increase in capitation rate payments to the MCOs.
- Post-payment review does not apply to retroactive Medicaid cost settlements or rate changes based on a Medicaid or Medicare cost report.
- According to the HHS, the fiscal impact will fall solely upon State Medicaid’s FFS program at a cost of approximately $535,000 annually.
- The Bill takes effect upon enactment; however, the impact to the HHS is estimated to begin in FY 2025.
- The State fiscal impact will include increased costs to the General Fund Medical Assistance (Medicaid) appropriation.
Fiscal Impact
House File 2268 is estimated to increase costs to the State Medicaid program by approximately $535,000 annually due to lost recoveries, beginning in FY 2025.
Source
- Department of Health and Human Services
- Medicaid, Refunds and Offsets · February 20, 2024 · $535,000
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90th General Assembly
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Earlier and later bills are matched by wording or an identical title.
Tried before
This idea has been filed in an earlier General Assembly. A version became law.
- HF 736 Relating to recovery of an overpayment to a provider based on specified grounds under the …89th General Assembly · Signed by Governor · nearly identicalBecame law
Similar bills this General Assembly
- 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.