House Study Bill 501 - Introduced HOUSE FILE _____ BY (PROPOSED COMMITTEE ON HEALTH AND HUMAN SERVICES BILL BY CHAIRPERSON MEYER) A BILL FOR An Act relating to limitations on activities related to paid 1 claims under the Medicaid program, and including effective 2 date provisions. 3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 4 TLSB 5556YC (3) 90 pf/ko

H.F. _____ Section 1. NEW SECTION . 249A.42B Limitations on activities 1 related to paid claims —— resubmission. 2 1. Notwithstanding any provision of law to the contrary, 3 any post-payment review of Medicaid provider claims paid under 4 either Medicaid fee-for-service or managed care administration 5 that do not involve fraud or misrepresentation shall be 6 limited to a review of only those claims for which no more than 7 twenty-four months have elapsed since the date of payment of 8 the claim. 9 2. Additionally, any provider overpayment identified for 10 which twenty-four months or more have elapsed since the date 11 of payment of the claim shall not be subject to repayment or to 12 offset against future reimbursement of claims by the provider. 13 3. The limitations specified in this section shall not apply 14 to retroactive Medicaid cost settlements or rate changes based 15 on a Medicaid or Medicare cost report. 16 4. Any improper payment identified through a review may be 17 resubmitted by the provider as a claims adjustment. 18 Sec. 2. EFFECTIVE DATE. This Act, being deemed of immediate 19 importance, takes effect upon enactment. 20 EXPLANATION 21 The inclusion of this explanation does not constitute agreement with 22 the explanation’s substance by the members of the general assembly. 23 This bill relates to the limitations on activities related 24 to paid claims under the Medicaid program. 25 The bill provides that notwithstanding any provision of 26 law to the contrary, any post-payment review of Medicaid 27 provider claims paid under either Medicaid fee-for-service 28 or managed care administration that do not involve fraud or 29 misrepresentation shall be limited to a review of only those 30 claims for which no more than 24 months have elapsed since 31 the date of payment of the claim. Additionally, any provider 32 overpayment identified for which 24 months or more have elapsed 33 since the date of payment of the claim shall not be subject 34 to repayment or to offset against future reimbursement of 35 -1- LSB 5556YC (3) 90 pf/ko 1/ 2

H.F. _____ claims by the provider. Any improper payment identified 1 through a review may be resubmitted by the provider as a claims 2 adjustment. 3 The bill takes effect upon enactment. 4 -2- LSB 5556YC (3) 90 pf/ko 2/ 2