S.F. _____ H.F. _____ 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. For purposes of repayment, an overpayment may 18 include interest in accordance with section 249A.41. 19 Sec. 3. NEW SECTION . 249A.39 Reporting of overpayment. 20 1. A provider who has received an overpayment shall notify 21 in writing, and return the overpayment to, the department, 22 the department’s agent, or the department’s contractor, as 23 appropriate. The notification shall include the reason for the 24 return of the overpayment. 25 2. Notification and return of an overpayment under this 26 section shall be provided by no later than the earlier of 27 either of the following, as applicable: 28 a. The date which is sixty days after the date on which the 29 overpayment was identified by the provider. 30 b. The date any corresponding cost report is due. 31 3. A violation of this section is a violation of chapter 32 685. 33 Sec. 4. NEW SECTION . 249A.40 Dissolved providers —— 34 overpayments or incorrect payments. 35 -1- LSB 1263XD (9) 85 pf/nh 1/ 17

S.F. _____ H.F. _____ Medical assistance paid to a provider following 1 administrative dissolution of the provider pursuant to chapter 2 490, division XIV, part B, shall be considered incorrectly paid 3 for the purposes of section 249A.5 and the provider shall be 4 considered to have received an overpayment for the purposes 5 of this subchapter. Notwithstanding section 490.1422, or any 6 other similar retroactive provision for reinstatement, the 7 director shall recoup any medical assistance paid to a provider 8 while the provider was dissolved. The principals of the 9 provider shall be personally liable for the incorrect payment 10 or overpayment. 11 Sec. 5. NEW SECTION . 249A.41 Overpayment —— interest. 12 1. Interest may be collected upon any overpayment 13 determined to have been made and shall accrue at the rate and 14 in the manner specified in this section. 15 2. Prior to the provision of a notice of overpayment to the 16 provider pursuant to section 249A.30, interest shall accrue at 17 the statutory rate for prejudgment interest applicable in civil 18 actions. 19 3. After the provision of a notice of overpayment to the 20 provider, interest shall accrue at the statutory rate for 21 prejudgment interest applicable in civil actions plus five 22 percent per annum, or the maximum legal rate, whichever is 23 lower. 24 4. At the discretion of the director, interest on an 25 overpayment may be waived in whole or in part when the 26 department determines the imposition of interest would produce 27 an unjust result, would unduly burden the provider, or would 28 substantially delay the prompt and efficient resolution of an 29 outstanding audit or investigation. 30 Sec. 6. NEW SECTION . 249A.42 Overpayment —— limitations 31 periods. 32 1. An administrative action to recover an overpayment to a 33 provider shall be commenced within ten years of the date the 34 overpayment was incurred. 35 -2- LSB 1263XD (9) 85 pf/nh 2/ 17

S.F. _____ H.F. _____ 2. An administrative action to impose a sanction related 1 to an overpayment to a provider shall be commenced within 2 five years of the date the conduct underlying the sanction 3 concluded, or the director discovered such conduct, whichever 4 is later. 5 Sec. 7. NEW SECTION . 249A.43 Provider overpayment —— notice 6 —— judgment. 7 1. Any overpayment to a provider under this chapter shall 8 become a judgment against the provider, by operation of law, 9 ninety days after the notice of overpayment is personally 10 served upon the enrolled provider as required in the Iowa 11 rules of civil procedure or by certified mail, return receipt 12 requested, by the director or the attorney general. The 13 judgment is entitled to full faith and credit in all states. 14 2. The notice of overpayment shall include the amount and 15 cause of the overpayment, the provider’s appeal rights, and a 16 disclaimer that a judgment may be established if an appeal is 17 not timely filed or if an appeal is filed and at the conclusion 18 of the administrative process under chapter 17A a determination 19 is made that there is an overpayment. 20 3. An affidavit of service of a notice of entry of judgment 21 shall be made by first class mail at the address where the 22 debtor was served with the notice of overpayment. Service is 23 completed upon mailing as specified in this paragraph. 24 4. On or after the date an unpaid overpayment becomes a 25 judgment by operation of law, the director or the attorney 26 general may file all of the following with the district court: 27 a. A statement identifying, or a copy of, the notice of 28 overpayment. 29 b. Proof of service of the notice of overpayment. 30 c. An affidavit of default, stating the full name, 31 occupation, place of residence, and last known post office 32 address of the debtor; the name and post office address of the 33 department; the date or dates the overpayment was incurred; 34 the program under which the debtor was overpaid; and the total 35 -3- LSB 1263XD (9) 85 pf/nh 3/ 17

S.F. _____ H.F. _____ amount of the judgment. 1 5. Nothing in this section shall be construed to impede or 2 restrict alternative methods of recovery of the overpayments 3 specified in this section or of overpayments which do not meet 4 the requirements of this section. 5 Sec. 8. NEW SECTION . 249A.44 Overpayment —— emergency 6 relief. 7 1. Concurrently with a withholding of payment, the 8 imposition of a sanction, or the institution of a criminal, 9 civil, or administrative proceeding against a provider or 10 other person for overpayment, the director or the attorney 11 general may bring an action for a temporary restraining order 12 or injunctive relief to prevent a provider or other person 13 from whom recovery may be sought, from transferring property 14 or otherwise taking action to protect the provider’s or other 15 person’s business inconsistent with the recovery sought. 16 2. To obtain such relief, the director or the attorney 17 general shall demonstrate all necessary requirements for the 18 relief to be granted. 19 3. If an injunction is granted, the court may appoint a 20 receiver to protect the property and business of the provider 21 or other person from whom recovery may be sought. The court 22 shall assess the costs of the receiver to the provider or other 23 person. 24 4. The director or the attorney general may file a lis 25 pendens on the property of the provider or other person 26 during the pendency of a criminal, civil, or administrative 27 proceeding. 28 5. When requested by the court, the director, or the 29 attorney general, a provider or other person from whom recovery 30 may be sought shall have an affirmative duty to fully disclose 31 all property and liabilities to the requester. 32 6. An action brought under this section may be brought in 33 the district court for Polk county or any other county in which 34 a provider or other person from whom recovery may be sought has 35 -4- LSB 1263XD (9) 85 pf/nh 4/ 17

S.F. _____ H.F. _____ its principal place of business or is domiciled. 1 Sec. 9. NEW SECTION . 249A.45 Provider’s third-party 2 submissions. 3 1. The department may refuse to accept a financial and 4 statistical report, cost report, or any other submission 5 from any third party acting under a provider’s authority or 6 direction to prepare or submit such documents or information, 7 for good cause shown. For the purposes of this section, 8 “good cause” , includes but is not limited to a pattern or 9 practice of submitting unallowable costs on cost reports; 10 making a false statement or certification to the director or 11 any representative of the department; professional negligence 12 or other demonstrated lack of knowledge of the cost reporting 13 process; conviction under a federal or state law relating to 14 the operation of a publicly funded program; or submission of a 15 false claim under chapter 685. 16 2. If the department refuses to accept a cost report 17 from a third party for good cause under this section, the 18 third party shall be strictly liable to the provider for all 19 fees incurred in preparation of the cost report, as well as 20 reasonable attorney fees and costs. The department shall not 21 take any adverse action against a provider that results from 22 the unintentional delay in the submission of a new cost report 23 or other submission necessitated by the department’s refusal to 24 accept a cost report or other submission under this section. 25 Sec. 10. NEW SECTION . 249A.46 Liability of other persons 26 —— repayment of claims. 27 1. The department may require repayment of medical 28 assistance paid from the person submitting an incorrect or 29 improper claim, the person causing the claim to be submitted, 30 or the person receiving payment for the claim. 31 2. The department may require repayment of medical 32 assistance paid for inappropriate, improper, unnecessary, 33 or excessive care, services, or supplies from the person 34 furnishing the care, services, or supplies; the person 35 -5- LSB 1263XD (9) 85 pf/nh 5/ 17

S.F. _____ H.F. _____ under whose supervision the care, services, or supplies 1 were furnished; or the person causing the care, services, or 2 supplies to be furnished. In such an instance, the department 3 may recover the amount paid for such care, services, or 4 supplies from the person ordering or prescribing the care, 5 services, or supplies, even though payment was made to another 6 person. Medical care, services, or supplies ordered or 7 prescribed shall be considered excessive or not medically 8 necessary unless the medical basis and specific need for the 9 care, services, or supplies are fully and properly documented 10 in the client’s medical record. 11 3. Any person furnishing, or supervising the furnishing of, 12 medical care, services, or supplies is jointly and severally 13 liable for any overpayments resulting from the furnishing of 14 the care, services, or supplies. The amount of repayment 15 which may be recovered from any person under this section is 16 the amount paid for furnishing the medical care, services, or 17 supplies, plus the amount paid to any other person as a result 18 of the person’s ordering or prescribing medical care, services, 19 or supplies, less any amount actually recovered from any other 20 person which relates to the care, services, or supplies for 21 which repayment is sought. 22 4. Nothing in this section shall be construed to impede or 23 restrict alternative recovery methods for claims specified in 24 this section or claims which do not meet the requirements of 25 this section. 26 Sec. 11. NEW SECTION . 249A.47 Improperly filed claims 27 —— other violations —— imposition of monetary recovery and 28 sanctions. 29 1. In addition to any other remedies or penalties prescribed 30 by law, including but not limited to those specified pursuant 31 to section 249A.8 or chapter 685, all of the following shall be 32 applicable to violations under the medical assistance program: 33 a. A person who knowingly presents or causes to be presented 34 to the department a claim that the department determines meets 35 -6- LSB 1263XD (9) 85 pf/nh 6/ 17

S.F. _____ H.F. _____ any of the following criteria is subject to a civil penalty of 1 not more than ten thousand dollars for each item or service: 2 (1) A claim for medical or other items or services that 3 the provider knows or should have known was not provided as 4 claimed, including a claim by any provider who engages in a 5 pattern or practice of presenting or causing to be presented 6 a claim for an item or service that is based on a billing code 7 that the provider knows or should have known will result in 8 a greater payment to the provider than the billing code the 9 provider knows or should have known is applicable to the item 10 or service actually provided. 11 (2) A claim for medical or other items or services the 12 provider knows or should have known to be false or fraudulent. 13 (3) A claim for a physician service or an item or service 14 incident to a physician service by a person who knows or should 15 have known that the individual who furnished or supervised the 16 furnishing of the service meets any of the following: 17 (a) Was not licensed as a physician. 18 (b) Was licensed as a physician, but such license had been 19 obtained through a misrepresentation of material fact. 20 (c) Represented to the patient at the time the service 21 was furnished that the physician was certified in a medical 22 specialty by a medical specialty board when the individual was 23 not so certified. 24 (4) A claim for medical or other items or services furnished 25 during a period in which the provider was excluded from 26 providing such items or services. 27 (5) A claim for a pattern of medical or other items or 28 services that a provider knows or should have known were not 29 medically necessary. 30 b. A provider who knowingly presents or causes to be 31 presented to any person a request for payment which is in 32 violation of the terms of either of the following is subject to 33 a civil penalty of not more than ten thousand dollars for each 34 item or service: 35 -7- LSB 1263XD (9) 85 pf/nh 7/ 17

S.F. _____ H.F. _____ (1) An agreement with the department or a requirement of a 1 state plan under Tit. XIX or XXI of the federal Social Security 2 Act not to charge a person for an item or service in excess of 3 the amount permitted to be charged. 4 (2) An agreement to be a participating provider. 5 c. A provider who is not an organization, agency, or 6 other entity, and knowing that the provider is excluded from 7 participating in a program under Tit. XVIII, XIX, or XXI of the 8 federal Social Security Act at the time of the exclusion, who 9 does any of the following, is subject to a civil penalty of ten 10 thousand dollars for each day that the prohibited relationship 11 occurs: 12 (1) Retains a direct or indirect ownership or control 13 interest in an entity that is participating in such programs, 14 and knows or should have known of the action constituting the 15 basis for the exclusion. 16 (2) Is an officer or managing employee of such an entity. 17 d. A provider who knowingly offers to or transfers 18 remuneration to any individual eligible for benefits under Tit. 19 XIX or XXI of the federal Social Security Act and who knows 20 or should have known such offer or remuneration is likely to 21 influence such individual to order or receive from a particular 22 provider any item or service for which payment may be made, in 23 whole or in part, under Tit. XIX or XXI of the federal Social 24 Security Act, is subject to a civil penalty of not more than 25 ten thousand dollars for each item or service. 26 e. A provider who knowingly arranges or contracts, by 27 employment or otherwise, with an individual or entity that 28 the provider knows or should have known is excluded from 29 participation under Tit. XVIII, XIX, or XXI of the federal 30 Social Security Act, for the provision of items or services for 31 which payment may be made under such titles, is subject to a 32 civil penalty of not more than ten thousand dollars for each 33 item or service. 34 f. A provider who knowingly offers, pays, solicits, or 35 -8- LSB 1263XD (9) 85 pf/nh 8/ 17

S.F. _____ H.F. _____ receives payment, directly or indirectly, to reduce or limit 1 services provided to any individual eligible for benefits under 2 Tit. XVIII, XIX, or XXI of the federal Social Security Act, 3 is subject to a civil penalty of not more than fifty thousand 4 dollars for each act. 5 g. A provider who knowingly makes, uses, or causes to 6 be made or used, a false record or statement material to a 7 false or fraudulent claim for payment for items and services 8 furnished under Tit. XIX or XXI of the federal Social Security 9 Act, is subject to a civil penalty of not more than fifty 10 thousand dollars for each false record or statement. 11 h. A provider who knowingly fails to grant timely access, 12 upon reasonable request, to the department for the purpose of 13 audits, investigations, evaluations, or other functions of the 14 department, is subject to a civil penalty of fifteen thousand 15 dollars for each day of the failure. 16 i. A provider who knowingly makes or causes to be made any 17 false statement, omission, or misrepresentation of a material 18 fact in any application, bid, or contract to participate 19 or enroll as a provider of services or a supplier under 20 Tit. XVIII, XIX, or XXI of the federal Social Security Act, 21 including a managed care organization or entity that applies 22 to participate as a provider of services or supplier in such 23 a managed care organization or plan, is subject to a civil 24 penalty of fifty thousand dollars for each false statement, 25 omission, or misrepresentation of a material fact. 26 j. A provider who knows of an overpayment and does not 27 report and return the overpayment in accordance with section 28 249A.41 is subject to a civil penalty of ten thousand dollars 29 for each failure to report and return an overpayment. 30 2. In addition to the civil penalties prescribed under 31 subsection 1, for any violation specified in subsection 1, a 32 provider shall be subject to the following, as applicable: 33 a. For violations specified in subsection 1, paragraph 34 “a” , “b” , “c” , “d” , “e” , “g” , “h” , or “j” , an assessment of not 35 -9- LSB 1263XD (9) 85 pf/nh 9/ 17

S.F. _____ H.F. _____ more than three times the amount claimed for each such item or 1 service in lieu of damages sustained by the department because 2 of such claim. 3 b. For a violation specified in subsection 1, paragraph 4 “f” , damages of not more than three times the total amount of 5 remuneration offered, paid, solicited, or received, without 6 regard to whether a portion of such remuneration was offered, 7 paid, solicited, or received for a lawful purpose. 8 c. For a violation specified in subsection 1, paragraph “i” , 9 an assessment of not more than three times the total amount 10 claimed for each item or service for which payment was made 11 based upon the application containing the false statement, 12 omission, or misrepresentation of a material fact. 13 3. In determining the amount or scope of any penalty 14 or assessment imposed pursuant to a violation specified in 15 subsection 1, the director shall consider all of the following: 16 a. The nature of the claims and the circumstances under 17 which they were presented. 18 b. The degree of culpability, history of prior offenses, and 19 financial condition of the person against whom the penalties or 20 assessments are levied. 21 c. Such other matters as justice may require. 22 4. Of any amount recovered arising out of a claim under Tit. 23 XIX or XXI of the federal Social Security Act, the department 24 shall receive the amount bearing the same proportion paid by 25 the department for such claims, including any federal share 26 that must be returned to the centers for Medicare and Medicaid 27 services of the United States department of human services. 28 The remainder of any amount recovered shall be deposited in the 29 general fund of the state. 30 5. Civil penalties levied under this section are appealable 31 under 441 IAC ch. 7, but, notwithstanding any provision to the 32 contrary in that chapter, the appellant shall bear the burden 33 to prove by clear and convincing evidence that the claim was 34 not filed improperly. 35 -10- LSB 1263XD (9) 85 pf/nh 10/ 17

S.F. _____ H.F. _____ 6. For the purposes of this section, “claim” includes but is 1 not limited to the submission of a cost report. 2 Sec. 12. NEW SECTION . 249A.48 Costs. 3 1. The department may seek recovery of investigative costs 4 from any provider or other person who submits, or causes to 5 be submitted, a claim for reimbursement for services the 6 provider or other person knows or reasonably should have known 7 would result in the incorrect payment of medical assistance. 8 Investigative costs include but are not limited to the costs 9 the department incurs in an audit and reasonable attorney fees. 10 Investigative costs do not include billing errors that result 11 in unintentional overcharges. 12 2. For the purposes of calculating a rate of payment for 13 a provider, allowable costs shall not include professional 14 fees, including but not limited to accountant or attorney 15 fees, incurred by the provider relating to any proceeding or 16 prospective proceeding relating to overpayment, sanction, or 17 other medical assistance program integrity proceedings. 18 Sec. 13. NEW SECTION . 249A.49 Temporary moratoria. 19 1. The Iowa Medicaid enterprise shall impose a temporary 20 moratorium on the enrollment of new providers or provider types 21 identified by the centers for Medicare and Medicaid services of 22 the United States department of health and human services as 23 posing an increased risk to the medical assistance program. 24 a. This section shall not be interpreted to require the 25 Iowa Medicaid enterprise to impose a moratorium if the Iowa 26 Medicaid enterprise determines that imposition of a temporary 27 moratorium would adversely affect access of recipients to 28 medical assistance services. 29 b. If the Iowa Medicaid enterprise makes a determination 30 as specified in paragraph “a” , the Iowa Medicaid enterprise 31 shall notify the centers for Medicare and Medicaid services of 32 the United States department of health and human services in 33 writing. 34 2. The Iowa Medicaid enterprise may impose a temporary 35 -11- LSB 1263XD (9) 85 pf/nh 11/ 17

S.F. _____ H.F. _____ moratorium on the enrollment of new providers, or impose 1 numerical caps or other limits that the Iowa Medicaid 2 enterprise and the centers for Medicare and Medicaid services 3 identify as having a significant potential for fraud, waste, or 4 abuse. 5 a. Before implementing the moratorium, caps, or other 6 limits, the Iowa Medicaid enterprise shall determine that its 7 action would not adversely impact access by recipients to 8 medical assistance services. 9 b. The Iowa Medicaid enterprise shall notify, in writing, 10 the centers for Medicare and Medicaid services, if the Iowa 11 Medicaid enterprise seeks to impose a moratorium under this 12 subsection, including all of the details of the moratorium. 13 The Iowa Medicaid enterprise shall receive approval from the 14 centers for Medicare and Medicaid services prior to imposing a 15 moratorium under this subsection. 16 3. a. The Iowa Medicaid enterprise shall impose any 17 moratorium for an initial period of six months. 18 b. If the Iowa Medicaid enterprise determines that it 19 is necessary, the Iowa Medicaid enterprise may extend the 20 moratorium in six-month increments. Each time a moratorium 21 is extended, the Iowa Medicaid enterprise shall document, in 22 writing, the necessity for extending the moratorium. 23 Sec. 14. NEW SECTION . 249A.50 Internet site —— providers 24 found in violation of medical assistance program. 25 1. The director shall maintain on the department’s internet 26 site, in a manner readily accessible by the public, all of the 27 following: 28 a. A list of all providers that the department has 29 terminated, suspended, placed on probation, or otherwise 30 sanctioned. 31 b. A list of all providers that have failed to return an 32 identified overpayment of medical assistance within the time 33 frame specified in section 249A.41. 34 c. A list of all providers found liable for a false claims 35 -12- LSB 1263XD (9) 85 pf/nh 12/ 17

S.F. _____ H.F. _____ law violation related to the medical assistance program under 1 chapter 685. 2 2. The director shall take all appropriate measures to 3 safeguard the protected health information, social security 4 numbers, and other information of the individuals involved, 5 which may be redacted or omitted as provided in rule of civil 6 procedure 1.422. A provider shall not be included on the 7 internet site until all administrative and judicial remedies 8 relating to the violation have been exhausted. 9 Sec. 15. CODE EDITOR DIRECTIVES. The Code editor shall do 10 all of the following: 11 1. Create a new subchapter in chapter 249A, entitled 12 “Medical Assistance Eligibility and Miscellaneous Provisions”, 13 which shall include sections 249A.1 through 249A.4, section 14 249A.4B, sections 249A.9 through 249A.13, sections 249A.15 15 through 249A.18A, and sections 249A.20 through 249A.38, 16 Code 2013. The Code editor may renumber sections within the 17 subchapter and shall correct internal references as necessary. 18 2. Create a new subchapter in chapter 249A, entitled 19 “Medical Assistance Program Integrity”, which shall include 20 sections 249A.39 through 249A.50, as enacted in this Act. 21 3. a. Transfer section 249A.4A, sections 249A.5 through 22 249A.8, section 249A.14, and section 249A.19, Code 2013, to the 23 new subchapter entitled “Medical Assistance Program Integrity”. 24 The Code editor shall renumber the transferred sections as 25 follows: 26 (1) Section 249A.4A as section 249A.53. 27 (2) Section 249A.5 as section 249A.54. 28 (3) Section 249A.6 as section 249A.55. 29 (4) Section 249A.6A as section 249A.56. 30 (5) Section 249A.7 as section 249A.51. 31 (6) Section 249A.8 as section 249A.52. 32 (7) Section 249A.14 as section 249A.57. 33 (8) Section 249A.19 as section 249A.58. 34 b. The Code editor shall correct internal references as 35 -13- LSB 1263XD (9) 85 pf/nh 13/ 17

S.F. _____ H.F. _____ necessary. 1 EXPLANATION 2 This bill relates to medical assistance (Medicaid) program 3 integrity. 4 The bill amends Code section 10A.108, which provides that 5 if a person refuses or neglects to repay benefits or provider 6 payments inappropriately obtained from the department of human 7 services (DHS), the amount inappropriately obtained constitutes 8 a debt and is a lien in favor of the state upon all property 9 belonging to the person. The bill provides that DHS is no 10 longer responsible for paying the fee for recording of the 11 satisfaction of the lien or the debt, but that this is the 12 responsibility of the debtor. 13 The bill requires a provider who has received an overpayment 14 to provide notification in writing and return the overpayment 15 to the department, department’s agent, or the department’s 16 contractor, as applicable. The notification and return of 17 the overpayment are to be completed the earlier of 60 days 18 after the date on which the overpayment was identified by the 19 provider or the date any corresponding cost report is due, 20 as applicable. Violation of this provision constitutes a 21 violation of the false claims Act (Code chapter 685). 22 The bill provides that if a provider is administratively 23 dissolved and receives payments following the dissolution, 24 the payments are considered to be overpayments and to be 25 incorrectly paid. 26 The bill provides for the accrual of interest on, and the 27 rate of interest applicable to, overpayments. 28 The bill requires that an administrative action to recover 29 an overpayment be commenced within 10 years of the date the 30 overpayment occurred. An administrative action to impose 31 a sanction on a provider related to an overpayment must be 32 commenced within five years of the date the conduct underlying 33 the sanction concluded, or the director of human services 34 discovered such conduct, whichever is first. 35 -14- LSB 1263XD (9) 85 pf/nh 14/ 17

S.F. _____ H.F. _____ The bill provides a process to establish a judgment by 1 operation of law for any overpayment to a Medicaid provider 2 90 days after the notice of overpayment is served upon the 3 provider. 4 The bill provides for emergency relief relating to 5 overpayments to Medicaid providers or others. The bill 6 provides that the director of human services or the attorney 7 general may bring an action for a temporary restraining order 8 or injunctive relief to prevent a provider or other person from 9 transferring property or otherwise taking actions to protect 10 the provider’s or other person’s business inconsistent with the 11 recovery being sought. 12 The bill authorizes DHS to refuse to accept financial and 13 statistical reports, cost reports, and other submissions from 14 third parties acting under the authority or direction of a 15 provider for good cause, and defines “good cause”. If DHS 16 refuses to accept a submission from such a third party, the 17 third party is strictly liable to the provider for all fees 18 incurred, attorney fees, and other costs. The bill provides 19 that DHS shall not take any adverse action against the provider 20 under circumstance that result from any unintentional delay on 21 the part of the provider in submitting a new submission. 22 The bill provides for repayment by persons other than the 23 provider for improper payments including the person submitting 24 an incorrect or improper claim, the person causing the claim 25 to be submitted, or the person receiving payment for the 26 claim. The bill also provides that DHS may require repayment 27 for inappropriate, improper, unnecessary, or excessive care, 28 services, or supplies from the person furnishing them, the 29 person under whose supervision they were furnished, or the 30 person causing them to be furnished. Any person furnishing, 31 or supervising the furnishing of, medical care, services, or 32 supplies is jointly and severally liable for any overpayments 33 resulting from the furnishing of the care, services, or 34 supplies. 35 -15- LSB 1263XD (9) 85 pf/nh 15/ 17

S.F. _____ H.F. _____ The bill provides specific civil penalties and assessments 1 or damages for improperly filed claims and other violations 2 relating to improper reimbursement under the Medicaid program. 3 The bill authorizes the department to recover investigative 4 costs from any provider or other person who submits, or causes 5 to be submitted, a claim for reimbursement for services the 6 provider or other person knows or reasonably should have known 7 would result in the incorrect payment of medical assistance. 8 The bill also provides that in calculating a rate of payment 9 for a provider, allowable costs do not include professional 10 fees incurred by the provider relating to any Medicaid program 11 integrity proceeding. 12 The bill directs the Iowa Medicaid enterprise (IME) to 13 impose temporary moratoria on enrollment of new providers or 14 provider types identified by the centers for Medicare and 15 Medicaid services of the United States department of health 16 and human services (CMS) as posing an increased risk to the 17 Medicaid program. The moratoria are not required if the IME 18 determines that imposition of a temporary moratorium would 19 adversely affect access of recipients to Medicaid services. 20 However, if the IME makes such a determination, IME is to 21 notify CMS in writing. The bill also authorizes IME to 22 impose temporary moratoria on enrollment of new providers, or 23 impose numerical caps or other limits that the IME and CMS 24 identify as having a significant potential for fraud, waste, 25 or abuse. Before implementing the moratoria, caps, or other 26 limits, IME must determine that its action would not adversely 27 impact access by recipients to Medicaid services, notify CMS 28 in writing, and receive approval from CMS. Any moratorium is 29 to be imposed for an initial period of six months and may then 30 be extended in six-month increments. The necessity for any 31 extension is to be documented in writing. 32 The bill requires the director of human services to maintain 33 on the department’s internet site, in a manner readily 34 accessible by the public, lists of all providers that the 35 -16- LSB 1263XD (9) 85 pf/nh 16/ 17

S.F. _____ H.F. _____ department has terminated, suspended, placed on probation, or 1 otherwise sanctioned; all providers that have failed to return 2 an identified overpayment; and all providers found liable for a 3 false claims law violation related to Medicaid. 4 The bill provides for all Medicaid program integrity 5 provisions to be codified in a new subchapter under Code 6 chapter 249A (medical assistance), including the new provisions 7 enacted in the bill and existing provisions under Code sections 8 249A.4A (garnishment), 249A.5 (recovery of payment), 249A.6 9 (assignment —— lien), 249A.6A (restitution), 249A.7 (fraudulent 10 practices —— investigations and audits —— Medicaid fraud fund), 11 249A.8 (fraudulent practice), 249A.14 (county attorney to 12 enforce), and 249A.19 (health care facilities —— penalty). 13 -17- LSB 1263XD (9) 85 pf/nh 17/ 17