House File 736 S-5064 Amend House File 736, as amended, passed, and reprinted by 1 the House, as follows: 2 1. By striking everything after the enacting clause and 3 inserting: 4 < Section 1. NEW SECTION . 249A.42A Overpayment —— 5 subsequent ineligibility of recipient —— commencement of action 6 and recovery. 7 1. Notwithstanding any provision to the contrary, if a 8 recipient is deemed ineligible for medical assistance following 9 delivery of care or service by a provider, any administrative 10 action to recover an overpayment to a provider based solely on 11 such recipient’s ineligibility shall be commenced within one 12 year of the date the overpayment was incurred. 13 2. In an administrative action to recover an overpayment 14 brought on the grounds specified in subsection 1, the 15 department acting as the state Medicaid agency shall reimburse 16 the provider for any recoupment of an overpayment using 17 state-only funds for care or services delivered if all of the 18 following conditions are met: 19 a. The provider verified eligibility through the eligibility 20 and verification system or the secure web portal of, and 21 obtained any necessary prior authorization for, the recipient 22 on whose behalf payment was made to the provider prior to the 23 delivery of care or service to the recipient. 24 b. The provider documented the eligibility verification 25 performed and any necessary prior authorization obtained 26 pursuant to paragraph “a” in a manner and format established by 27 the department by rule, and retained the required documentation 28 in the recipient’s file. 29 3. The one-year limitation period prescribed under this 30 section does not apply to recovery of an overpayment to a 31 provider in an administrative action brought on other grounds. 32 4. For the purposes of this section, “incurred” means the 33 same as defined in section 249A.42. > 34 2. Title page, by striking lines 1 through 3 and inserting 35 -1- HF 736.3821 (3) 89 pf/rh 1/ 2 #1.