H.F. 553 Section 1. Section 10A.108, subsections 6 and 7, Code 2013, 1 are amended to read as follows: 2 6. The department shall pay, from moneys appropriated to 3 the department for this purpose, recording fees as provided 4 in section 331.604 , for the recording of the lien , or for 5 satisfaction of the lien . 6 7. Upon payment of a debt for which the director has filed 7 notice with a county recorder, the director shall file a 8 provide to the debtor a satisfaction of the debt . The debtor 9 shall be responsible for filing the satisfaction of the debt 10 with the recorder and the recorder shall enter the satisfaction 11 on the notice on file in the recorder’s office. 12 Sec. 2. Section 249A.2, Code 2013, is amended by adding the 13 following new subsection: 14 NEW SUBSECTION . 8A. “Overpayment” means any funds that 15 a provider receives or retains under the medical assistance 16 program to which the person, after applicable reconciliation, 17 is not entitled. To the extent the provider and the department 18 disagree as to whether the provider is entitled to funds 19 received or retained under the medical assistance program, 20 “overpayment” includes such funds for which the provider’s 21 administrative and judicial review remedies under 441 IAC 22 ch. 7 and chapter 17A have been exhausted. For purposes of 23 repayment, an overpayment may include interest in accordance 24 with section 249A.41. 25 Sec. 3. NEW SECTION . 249A.39 Reporting of overpayment. 26 1. A provider who has received an overpayment shall notify 27 in writing, and return the overpayment to, the department, 28 the department’s agent, or the department’s contractor, as 29 appropriate. The notification shall include the reason for the 30 return of the overpayment. 31 2. Notification and return of an overpayment under this 32 section shall be provided by no later than the later of either 33 of the following, as applicable: 34 a. The date which is sixty days after the date on which the 35 -1- LSB 1263HV (2) 85 pf/nh 1/ 16

H.F. 553 overpayment was identified by the provider. 1 b. The date any corresponding cost report is due. 2 3. A violation of this section is a violation of chapter 3 685. 4 Sec. 4. NEW SECTION . 249A.40 Involuntarily dissolved 5 providers —— overpayments or incorrect payments. 6 Medical assistance paid to a provider following involuntary 7 administrative dissolution of the provider pursuant to chapter 8 490, division XIV, part B, shall be considered incorrectly 9 paid for the purposes of section 249A.5 and the provider 10 shall be considered to have received an overpayment for the 11 purposes of this subchapter. For the purposes of this section, 12 the overpayment shall not accrue until after a grace period 13 of ninety days following receipt of notice by the provider 14 of the dissolution from the department. Notwithstanding 15 section 490.1422, or any other similar retroactive provision 16 for reinstatement, the director shall recoup any medical 17 assistance paid to a provider while the provider was dissolved 18 if the provider is not retroactively reinstated within the 19 ninety-day grace period. The principals of the provider shall 20 be personally liable for the incorrect payment or overpayment. 21 Sec. 5. NEW SECTION . 249A.41 Overpayment —— interest. 22 1. Interest may be collected upon any overpayment 23 determined to have been made and shall accrue at the rate and 24 in the manner specified in this section. 25 2. Prior to the provision of a notice of overpayment to 26 the provider, interest shall accrue at the statutory rate for 27 prejudgment interest applicable in civil actions. 28 3. After the provision of a notice of overpayment to the 29 provider and after all of the provider’s administrative and 30 judicial review remedies under 441 IAC ch. 7 and chapter 17A 31 have been exhausted, interest shall accrue at the statutory 32 rate for prejudgment interest applicable in civil actions plus 33 five percent per annum, or the maximum legal rate, whichever is 34 lower. 35 -2- LSB 1263HV (2) 85 pf/nh 2/ 16

H.F. 553 4. At the discretion of the director, interest on an 1 overpayment may be waived in whole or in part when the 2 department determines the imposition of interest would produce 3 an unjust result, would unduly burden the provider, or would 4 substantially delay the prompt and efficient resolution of an 5 outstanding audit or investigation. 6 Sec. 6. NEW SECTION . 249A.42 Overpayment —— limitations 7 periods. 8 1. An administrative action to recover an overpayment to a 9 provider shall be commenced within five years of the date the 10 overpayment was incurred. For the purposes of this subsection, 11 “incurred” means the date the medical assistance claim was 12 paid, or the date any applicable reconciliation was completed, 13 whichever is later. 14 2. An administrative action to impose a sanction related 15 to an overpayment to a provider shall be commenced within 16 five years of the date the conduct underlying the sanction 17 concluded, or the director discovered such conduct, whichever 18 is later. 19 Sec. 7. NEW SECTION . 249A.43 Provider overpayment —— notice 20 —— judgment. 21 1. Any overpayment to a provider under this chapter shall 22 become a judgment against the provider, by operation of law, 23 ninety days after a notice of overpayment is personally served 24 upon the enrolled provider as required in the Iowa rules of 25 civil procedure or by certified mail, return receipt requested, 26 by the director or the attorney general or, if applicable, 27 upon exhaustion of the provider’s administrative and judicial 28 review remedies under 441 IAC ch. 7 or chapter 17A, whichever 29 is later. The judgment is entitled to full faith and credit in 30 all states. 31 2. The notice of overpayment shall include the amount and 32 cause of the overpayment, the provider’s appeal rights, and a 33 disclaimer that a judgment may be established if an appeal is 34 not timely filed or if an appeal is filed and at the conclusion 35 -3- LSB 1263HV (2) 85 pf/nh 3/ 16

H.F. 553 of the administrative process under chapter 17A a determination 1 is made that there is an overpayment. 2 3. An affidavit of service of a notice of entry of judgment 3 shall be made by first class mail at the address where the 4 debtor was served with the notice of overpayment. Service is 5 completed upon mailing as specified in this paragraph. 6 4. On or after the date an unpaid overpayment becomes a 7 judgment by operation of law, the director or the attorney 8 general may file all of the following with the district court: 9 a. A statement identifying, or a copy of, the notice of 10 overpayment. 11 b. Proof of service of the notice of overpayment. 12 c. An affidavit of default, stating the full name, 13 occupation, place of residence, and last known post office 14 address of the debtor; the name and post office address of the 15 department; the date or dates the overpayment was incurred; 16 the program under which the debtor was overpaid; and the total 17 amount of the judgment. 18 5. Nothing in this section shall be construed to impede or 19 restrict alternative methods of recovery of the overpayments 20 specified in this section or of overpayments which do not meet 21 the requirements of this section. 22 Sec. 8. NEW SECTION . 249A.44 Overpayment —— emergency 23 relief. 24 1. Concurrently with a withholding of payment, the 25 imposition of a sanction, or the institution of a criminal, 26 civil, or administrative proceeding against a provider or 27 other person for overpayment, the director or the attorney 28 general may bring an action for a temporary restraining order 29 or injunctive relief to prevent a provider or other person 30 from whom recovery may be sought, from transferring property 31 or otherwise taking action to protect the provider’s or other 32 person’s business inconsistent with the recovery sought. 33 2. To obtain such relief, the director or the attorney 34 general shall demonstrate all necessary requirements for the 35 -4- LSB 1263HV (2) 85 pf/nh 4/ 16

H.F. 553 relief to be granted. 1 3. If an injunction is granted, the court may appoint a 2 receiver to protect the property and business of the provider 3 or other person from whom recovery may be sought. The court 4 shall assess the costs of the receiver to the provider or other 5 person. 6 4. The director or the attorney general may file a lis 7 pendens on the property of the provider or other person 8 during the pendency of a criminal, civil, or administrative 9 proceeding. 10 5. When requested by the court, the director, or the 11 attorney general, a provider or other person from whom recovery 12 may be sought shall have an affirmative duty to fully disclose 13 all property and liabilities to the requester. 14 6. An action brought under this section may be brought in 15 the district court for Polk county or any other county in which 16 a provider or other person from whom recovery may be sought has 17 its principal place of business or is domiciled. 18 Sec. 9. NEW SECTION . 249A.45 Provider’s third-party 19 submissions. 20 1. The department may refuse to accept a financial and 21 statistical report, cost report, or any other submission 22 from any third party acting under a provider’s authority or 23 direction to prepare or submit such documents or information, 24 for good cause shown. For the purposes of this section, 25 “good cause” , includes but is not limited to a pattern or 26 practice of submitting unallowable costs on cost reports; 27 making a false statement or certification to the director or 28 any representative of the department; professional negligence 29 or other demonstrated lack of knowledge of the cost reporting 30 process; conviction under a federal or state law relating to 31 the operation of a publicly funded program; or submission of a 32 false claim under chapter 685. 33 2. If the department refuses to accept a cost report 34 from a third party for good cause under this section, the 35 -5- LSB 1263HV (2) 85 pf/nh 5/ 16

H.F. 553 third party shall be strictly liable to the provider for all 1 fees incurred in preparation of the cost report, as well as 2 reasonable attorney fees and costs. The department shall not 3 take any adverse action against a provider that results from 4 the unintentional delay in the submission of a new cost report 5 or other submission necessitated by the department’s refusal to 6 accept a cost report or other submission under this section. 7 The department shall notify an affected provider within seven 8 business days of any refusal to accept a cost report. 9 Sec. 10. NEW SECTION . 249A.46 Liability of other persons 10 —— repayment of claims. 11 1. The department may require repayment of medical 12 assistance paid from the person submitting an incorrect or 13 improper claim, the person causing the claim to be submitted, 14 or the person receiving payment for the claim. 15 2. Nothing in this section shall be construed to impede or 16 restrict alternative recovery methods for claims specified in 17 this section or claims which do not meet the requirements of 18 this section. 19 Sec. 11. NEW SECTION . 249A.47 Improperly filed claims 20 —— other violations —— imposition of monetary recovery and 21 sanctions. 22 1. In addition to any other remedies or penalties prescribed 23 by law, including but not limited to those specified pursuant 24 to section 249A.8 or chapter 685, all of the following shall be 25 applicable to violations under the medical assistance program: 26 a. A person who intentionally and purposefully presents 27 or causes to be presented to the department a claim that the 28 department determines meets any of the following criteria 29 is subject to a civil penalty of not more than ten thousand 30 dollars for each item or service: 31 (1) A claim for medical or other items or services that 32 the provider knows was not provided as claimed, including a 33 claim by any provider who engages in a pattern or practice 34 of presenting or causing to be presented a claim for an item 35 -6- LSB 1263HV (2) 85 pf/nh 6/ 16

H.F. 553 or service that is based on a billing code that the provider 1 knows will result in a greater payment to the provider than the 2 billing code the provider knows is applicable to the item or 3 service actually provided. 4 (2) A claim for medical or other items or services the 5 provider knows to be false or fraudulent. 6 (3) A claim for a physician service or an item or service 7 incident to a physician service by a person who knows that the 8 individual who furnished or supervised the furnishing of the 9 service meets any of the following: 10 (a) Was not licensed as a physician. 11 (b) Was licensed as a physician, but such license had been 12 obtained through a misrepresentation of material fact. 13 (c) Represented to the patient at the time the service 14 was furnished that the physician was certified in a medical 15 specialty by a medical specialty board when the individual was 16 not so certified. 17 (4) A claim for medical or other items or services furnished 18 during a period in which the provider was excluded from 19 providing such items or services. 20 (5) A claim for a pattern of medical or other items or 21 services that a provider knows were not medically necessary. 22 b. A provider who intentionally and purposefully presents 23 or causes to be presented to any person a request for payment 24 which is in violation of the terms of either of the following 25 is subject to a civil penalty of not more than ten thousand 26 dollars for each item or service: 27 (1) An agreement with the department or a requirement of a 28 state plan under Tit. XIX or XXI of the federal Social Security 29 Act not to charge a person for an item or service in excess of 30 the amount permitted to be charged. 31 (2) An agreement to be a participating provider. 32 c. A provider who is not an organization, agency, or 33 other entity, and knowing that the provider is excluded from 34 participating in a program under Tit. XVIII, XIX, or XXI of the 35 -7- LSB 1263HV (2) 85 pf/nh 7/ 16

H.F. 553 federal Social Security Act at the time of the exclusion, who 1 does any of the following, is subject to a civil penalty of ten 2 thousand dollars for each day that the prohibited relationship 3 occurs: 4 (1) Retains a direct or indirect ownership or control 5 interest in an entity that is participating in such programs, 6 and knows of the action constituting the basis for the 7 exclusion. 8 (2) Is an officer or managing employee of such an entity. 9 d. A provider who intentionally and purposefully offers 10 to or transfers remuneration to any individual eligible for 11 benefits under Tit. XIX or XXI of the federal Social Security 12 Act and who knows such offer or remuneration is likely to 13 influence such individual to order or receive from a particular 14 provider any item or service for which payment may be made, in 15 whole or in part, under Tit. XIX or XXI of the federal Social 16 Security Act, is subject to a civil penalty of not more than 17 ten thousand dollars for each item or service. 18 e. A provider who intentionally and purposefully arranges or 19 contracts, by employment or otherwise, with an individual or 20 entity that the provider knows is excluded from participation 21 under Tit. XVIII, XIX, or XXI of the federal Social Security 22 Act, for the provision of items or services for which payment 23 may be made under such titles, is subject to a civil penalty of 24 not more than ten thousand dollars for each item or service. 25 f. A provider who intentionally and purposefully offers, 26 pays, solicits, or receives payment, directly or indirectly, to 27 reduce or limit services provided to any individual eligible 28 for benefits under Tit. XVIII, XIX, or XXI of the federal 29 Social Security Act, is subject to a civil penalty of not more 30 than fifty thousand dollars for each act. 31 g. A provider who intentionally and purposefully makes, 32 uses, or causes to be made or used, a false record or statement 33 material to a false or fraudulent claim for payment for items 34 and services furnished under Tit. XIX or XXI of the federal 35 -8- LSB 1263HV (2) 85 pf/nh 8/ 16

H.F. 553 Social Security Act, is subject to a civil penalty of not more 1 than fifty thousand dollars for each false record or statement. 2 h. A provider who intentionally and purposefully fails 3 to grant timely access, upon reasonable request and without 4 good cause, to the department for the purpose of audits, 5 investigations, evaluations, or other functions of the 6 department, is subject to a civil penalty of fifteen thousand 7 dollars for each day of the failure. 8 i. A provider who intentionally and purposefully makes 9 or causes to be made any false statement, omission, or 10 misrepresentation of a material fact in any application, bid, 11 or contract to participate or enroll as a provider of services 12 or a supplier under Tit. XVIII, XIX, or XXI of the federal 13 Social Security Act, including a managed care organization or 14 entity that applies to participate as a provider of services 15 or supplier in such a managed care organization or plan, is 16 subject to a civil penalty of fifty thousand dollars for each 17 false statement, omission, or misrepresentation of a material 18 fact. 19 j. A provider who intentionally and purposefully fails to 20 report and return an overpayment in accordance with section 21 249A.41 is subject to a civil penalty of ten thousand dollars 22 for each failure to report and return an overpayment. 23 2. In addition to the civil penalties prescribed under 24 subsection 1, for any violation specified in subsection 1, a 25 provider shall be subject to the following, as applicable: 26 a. For violations specified in subsection 1, paragraph 27 “a” , “b” , “c” , “d” , “e” , “g” , “h” , or “j” , an assessment of not 28 more than three times the amount claimed for each such item or 29 service in lieu of damages sustained by the department because 30 of such claim. 31 b. For a violation specified in subsection 1, paragraph 32 “f” , damages of not more than three times the total amount of 33 remuneration offered, paid, solicited, or received, without 34 regard to whether a portion of such remuneration was offered, 35 -9- LSB 1263HV (2) 85 pf/nh 9/ 16

H.F. 553 paid, solicited, or received for a lawful purpose. 1 c. For a violation specified in subsection 1, paragraph “i” , 2 an assessment of not more than three times the total amount 3 claimed for each item or service for which payment was made 4 based upon the application containing the false statement, 5 omission, or misrepresentation of a material fact. 6 3. In determining the amount or scope of any penalty 7 or assessment imposed pursuant to a violation specified in 8 subsection 1, the director shall consider all of the following: 9 a. The nature of the claims and the circumstances under 10 which they were presented. 11 b. The degree of culpability, history of prior offenses, and 12 financial condition of the person against whom the penalties or 13 assessments are levied. 14 c. Such other matters as justice may require. 15 4. Of any amount recovered arising out of a claim under Tit. 16 XIX or XXI of the federal Social Security Act, the department 17 shall receive the amount bearing the same proportion paid by 18 the department for such claims, including any federal share 19 that must be returned to the centers for Medicare and Medicaid 20 services of the United States department of human services. 21 The remainder of any amount recovered shall be deposited in the 22 general fund of the state. 23 5. Civil penalties levied under this section are appealable 24 under 441 IAC ch. 7, but, notwithstanding any provision to the 25 contrary in that chapter, the appellant shall bear the burden 26 to prove by clear and convincing evidence that the claim was 27 not filed improperly. 28 6. For the purposes of this section, “claim” includes but is 29 not limited to the submission of a cost report. 30 Sec. 12. NEW SECTION . 249A.48 Temporary moratoria. 31 1. The Iowa Medicaid enterprise shall impose a temporary 32 moratorium on the enrollment of new providers or provider types 33 identified by the centers for Medicare and Medicaid services of 34 the United States department of health and human services as 35 -10- LSB 1263HV (2) 85 pf/nh 10/ 16

H.F. 553 posing an increased risk to the medical assistance program. 1 a. This section shall not be interpreted to require the 2 Iowa Medicaid enterprise to impose a moratorium if the Iowa 3 Medicaid enterprise determines that imposition of a temporary 4 moratorium would adversely affect access of recipients to 5 medical assistance services. 6 b. If the Iowa Medicaid enterprise makes a determination 7 as specified in paragraph “a” , the Iowa Medicaid enterprise 8 shall notify the centers for Medicare and Medicaid services of 9 the United States department of health and human services in 10 writing. 11 2. The Iowa Medicaid enterprise may impose a temporary 12 moratorium on the enrollment of new providers, or impose 13 numerical caps or other limits that the Iowa Medicaid 14 enterprise and the centers for Medicare and Medicaid services 15 identify as having a significant potential for fraud, waste, or 16 abuse. 17 a. Before implementing the moratorium, caps, or other 18 limits, the Iowa Medicaid enterprise shall determine that its 19 action would not adversely impact access by recipients to 20 medical assistance services. 21 b. The Iowa Medicaid enterprise shall notify, in writing, 22 the centers for Medicare and Medicaid services, if the Iowa 23 Medicaid enterprise seeks to impose a moratorium under this 24 subsection, including all of the details of the moratorium. 25 The Iowa Medicaid enterprise shall receive approval from the 26 centers for Medicare and Medicaid services prior to imposing a 27 moratorium under this subsection. 28 3. a. The Iowa Medicaid enterprise shall impose any 29 moratorium for an initial period of six months. 30 b. If the Iowa Medicaid enterprise determines that it 31 is necessary, the Iowa Medicaid enterprise may extend the 32 moratorium in six-month increments. Each time a moratorium 33 is extended, the Iowa Medicaid enterprise shall document, in 34 writing, the necessity for extending the moratorium. 35 -11- LSB 1263HV (2) 85 pf/nh 11/ 16

H.F. 553 Sec. 13. NEW SECTION . 249A.49 Internet site —— providers 1 found in violation of medical assistance program. 2 1. The director shall maintain on the department’s internet 3 site, in a manner readily accessible by the public, all of the 4 following: 5 a. A list of all providers that the department has 6 terminated, suspended, or placed on probation. 7 b. A list of all providers that have failed to return an 8 identified overpayment of medical assistance within the time 9 frame specified in section 249A.41. 10 c. A list of all providers found liable for a false claims 11 law violation related to the medical assistance program under 12 chapter 685. 13 2. The director shall take all appropriate measures to 14 safeguard the protected health information, social security 15 numbers, and other information of the individuals involved, 16 which may be redacted or omitted as provided in rule of civil 17 procedure 1.422. A provider shall not be included on the 18 internet site until all administrative and judicial remedies 19 relating to the violation have been exhausted. 20 Sec. 14. CODE EDITOR DIRECTIVES. The Code editor shall do 21 all of the following: 22 1. Create a new subchapter in chapter 249A, entitled 23 “Medical Assistance Eligibility and Miscellaneous Provisions”, 24 which shall include sections 249A.1 through 249A.4, section 25 249A.4B, sections 249A.9 through 249A.13, sections 249A.15 26 through 249A.18A, and sections 249A.20 through 249A.38, 27 Code 2013. The Code editor may renumber sections within the 28 subchapter and shall correct internal references as necessary. 29 2. Create a new subchapter in chapter 249A, entitled 30 “Medical Assistance Program Integrity”, which shall include 31 sections 249A.39 through 249A.49, as enacted in this Act. 32 3. a. Transfer section 249A.4A, sections 249A.5 through 33 249A.8, section 249A.14, and section 249A.19, Code 2013, to the 34 new subchapter entitled “Medical Assistance Program Integrity”. 35 -12- LSB 1263HV (2) 85 pf/nh 12/ 16

H.F. 553 The Code editor shall renumber the transferred sections as 1 follows: 2 (1) Section 249A.4A as section 249A.52. 3 (2) Section 249A.5 as section 249A.53. 4 (3) Section 249A.6 as section 249A.54. 5 (4) Section 249A.6A as section 249A.55. 6 (5) Section 249A.7 as section 249A.50. 7 (6) Section 249A.8 as section 249A.51. 8 (7) Section 249A.14 as section 249A.56. 9 (8) Section 249A.19 as section 249A.57. 10 b. The Code editor shall correct internal references as 11 necessary. 12 EXPLANATION 13 This bill relates to medical assistance (Medicaid) program 14 integrity. 15 The bill amends Code section 10A.108, which provides that 16 if a person refuses or neglects to repay benefits or provider 17 payments inappropriately obtained from the department of human 18 services (DHS), the amount inappropriately obtained constitutes 19 a debt and is a lien in favor of the state upon all property 20 belonging to the person. The bill provides that DHS is no 21 longer responsible for paying the fee for recording of the 22 satisfaction of the lien or the debt, but that this is the 23 responsibility of the debtor. 24 The bill requires a provider who has received an overpayment 25 to provide notification in writing and return the overpayment 26 to the department, department’s agent, or the department’s 27 contractor, as applicable. The notification and return of the 28 overpayment are to be completed the later of 60 days after the 29 date on which the overpayment was identified by the provider or 30 the date any corresponding cost report is due, as applicable. 31 Violation of this provision constitutes a violation of the 32 false claims Act (Code chapter 685). 33 The bill provides that if a provider is administratively and 34 involuntarily dissolved and receives payments following the 35 -13- LSB 1263HV (2) 85 pf/nh 13/ 16

H.F. 553 dissolution, the payments are considered to be overpayments and 1 to be incorrectly paid. 2 The bill provides for the accrual of interest on, and the 3 rate of interest applicable to, overpayments. 4 The bill requires that an administrative action to recover 5 an overpayment be commenced within five years of the date the 6 overpayment occurred. An administrative action to impose 7 a sanction on a provider related to an overpayment must be 8 commenced within five years of the date the conduct underlying 9 the sanction concluded, or the director of human services 10 discovered such conduct, whichever is first. 11 The bill provides a process to establish a judgment by 12 operation of law for any overpayment to a Medicaid provider 13 90 days after the notice of overpayment is served upon the 14 provider or after all administrative and judicial review 15 remedies are exhausted. 16 The bill provides for emergency relief relating to 17 overpayments to Medicaid providers or others. The bill 18 provides that the director of human services or the attorney 19 general may bring an action for a temporary restraining order 20 or injunctive relief to prevent a provider or other person from 21 transferring property or otherwise taking actions to protect 22 the provider’s or other person’s business inconsistent with the 23 recovery being sought. 24 The bill authorizes DHS to refuse to accept financial and 25 statistical reports, cost reports, and other submissions from 26 third parties acting under the authority or direction of a 27 provider for good cause, and defines “good cause”. If DHS 28 refuses to accept a submission from such a third party, the 29 third party is strictly liable to the provider for all fees 30 incurred, attorney fees, and other costs. The bill provides 31 that DHS shall not take any adverse action against the provider 32 under circumstance that result from any unintentional delay on 33 the part of the provider in submitting a new submission. 34 The bill provides for repayment by persons other than the 35 -14- LSB 1263HV (2) 85 pf/nh 14/ 16

H.F. 553 provider for improper payments including the person submitting 1 an incorrect or improper claim, the person causing the claim to 2 be submitted, or the person receiving payment for the claim. 3 The bill provides specific civil penalties and assessments 4 or damages for improperly filed claims and other violations 5 relating to improper reimbursement under the Medicaid program. 6 The bill directs the Iowa Medicaid enterprise (IME) to 7 impose temporary moratoria on enrollment of new providers or 8 provider types identified by the centers for Medicare and 9 Medicaid services of the United States department of health 10 and human services (CMS) as posing an increased risk to the 11 Medicaid program. The moratoria are not required if the IME 12 determines that imposition of a temporary moratorium would 13 adversely affect access of recipients to Medicaid services. 14 However, if the IME makes such a determination, IME is to 15 notify CMS in writing. The bill also authorizes IME to 16 impose temporary moratoria on enrollment of new providers, or 17 impose numerical caps or other limits that the IME and CMS 18 identify as having a significant potential for fraud, waste, 19 or abuse. Before implementing the moratoria, caps, or other 20 limits, IME must determine that its action would not adversely 21 impact access by recipients to Medicaid services, notify CMS 22 in writing, and receive approval from CMS. Any moratorium is 23 to be imposed for an initial period of six months and may then 24 be extended in six-month increments. The necessity for any 25 extension is to be documented in writing. 26 The bill requires the director of human services to maintain 27 on the department’s internet site, in a manner readily 28 accessible by the public, lists of all providers that the 29 department has terminated, suspended, or placed on probation; 30 all providers that have failed to return an identified 31 overpayment; and all providers found liable for a false claims 32 law violation related to Medicaid. 33 The bill provides for all Medicaid program integrity 34 provisions to be codified in a new subchapter under Code 35 -15- LSB 1263HV (2) 85 pf/nh 15/ 16

H.F. 553 chapter 249A (medical assistance), including the new provisions 1 enacted in the bill and existing provisions under Code sections 2 249A.4A (garnishment), 249A.5 (recovery of payment), 249A.6 3 (assignment —— lien), 249A.6A (restitution), 249A.7 (fraudulent 4 practices —— investigations and audits —— Medicaid fraud fund), 5 249A.8 (fraudulent practice), 249A.14 (county attorney to 6 enforce), and 249A.19 (health care facilities —— penalty). 7 -16- LSB 1263HV (2) 85 pf/nh 16/ 16