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.