Proyectos de ley › 90.ª Asamblea General
Relating to limitations on activities related to paid claims under the Medicaid program, and including effective date provisions
Presentado por el comité Health and Human Services de la Cámara
Temas:Health careFamilies & human servicesMedicaid
La misma legislación: HSB 501
Dónde está ahora
- Hecho: Presentado8 de enero de 2024
- Hecho: Subcomité8 de enero de 2024
- Hecho: Comité de la Cámara30 de enero de 2024
- Se detuvo: Lo aprueba la CámaraMurió al terminar la Asamblea General
- Sigue: Comité del Senado
- Sigue: Lo aprueba el Senado
- Sigue: A gobernador(a)
- Sigue: Firmado como ley
Murió al terminar la sesión La sesión de 2024 terminó el 19 de abril de 2024, la última sesión ordinaria de la Asamblea General. Los proyectos que no pasaron por ambas cámaras murieron. ¿Qué es el embudo (funnel)?
Qué contiene
Resumen con IA 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. (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 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
Nota fiscal
Cost: up to $535,000 Compare con otros proyectos
Resumen con IA 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. (en inglés)3
Lea la nota fiscal (en inglés)
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 · 20 de febrero de 2024 · $535,000
Lo que cambia del Código de Iowa (Iowa Code)
Crea§249A.42B
Cabildeo
29 a favor · 0 en contra · 3 indecisos · Quiénes →
Family tree
Tried before
Study bill
90th General Assembly
Picked up later
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.