House
File
736
S-5095
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
——
recovery
——
recoupment
6
——
reimbursement.
7
Notwithstanding
any
provision
to
the
contrary,
if
a
recipient
8
is
deemed
ineligible
for
medical
assistance
following
delivery
9
of
care
or
service
by
a
provider,
in
an
administrative
action
10
to
recover
an
overpayment
to
the
provider
based
solely
on
the
11
grounds
of
such
recipient’s
ineligibility,
the
department
12
acting
as
the
state
Medicaid
agency
shall
reimburse
the
13
provider
for
any
recoupment
of
an
overpayment
using
state-only
14
funds
for
care
or
services
delivered
if
all
of
the
following
15
conditions
are
met:
16
1.
The
provider
verified
eligibility
through
the
17
eligibility
and
verification
system
or
the
secure
web
portal
18
of,
and
obtained
any
necessary
prior
authorization
for,
the
19
recipient
on
whose
behalf
payment
was
made
to
the
provider
20
prior
to
the
delivery
of
care
or
service
to
the
recipient.
21
2.
The
provider
documented
the
eligibility
verification
22
performed
and
any
necessary
prior
authorization
obtained
23
pursuant
to
paragraph
“a”
in
a
manner
and
format
established
by
24
the
department
by
rule,
and
retained
the
required
documentation
25
in
the
recipient’s
file.
>
26
2.
Title
page,
by
striking
lines
1
through
3
and
inserting
27
<
An
Act
relating
to
recovery
of
an
overpayment
to
a
provider
28
based
on
specified
grounds
under
the
Medicaid
program.
>
29
______________________________
MARK
COSTELLO
-1-
HF
736.3901
(5)
89
pf/rh
1/
1
#1.
#2.