HSB 501 (LSB 5556YC (3) 90)

HOUSE FILE _____ 

BY  (PROPOSED COMMITTEE ON HEALTH AND HUMAN SERVICES BILL BY CHAIRPERSON MEYER)

A BILL FOR

An Act relating to limitations on activities related to paid claims under the Medicaid program, and including effective date provisions.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  NEW SECTION.  249A.42B  Limitations on activities related to paid claims —— resubmission.
   1.  Notwithstanding any provision of law to the contrary, any post-payment review of Medicaid provider claims paid under either Medicaid fee-for-service or managed care administration that do not involve fraud or misrepresentation shall be limited to a review of only those claims for which no more than twenty-four months have elapsed since the date of payment of the claim.
   2.  Additionally, any provider overpayment identified for which twenty-four months or more have elapsed since the date of payment of the claim shall not be subject to repayment or to offset against future reimbursement of claims by the provider.
   3.  The limitations specified in this section shall not apply to retroactive Medicaid cost settlements or rate changes based on a Medicaid or Medicare cost report.
   4.  Any improper payment identified through a review may be resubmitted by the provider as a claims adjustment.
    Sec. 2.  EFFECTIVE DATE.  This Act, being deemed of immediate importance, takes effect upon enactment.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
   This bill relates to the limitations on activities related to paid claims under the Medicaid program.
   The bill provides that notwithstanding any provision of law to the contrary, any post-payment review of Medicaid provider claims paid under either Medicaid fee-for-service or managed care administration that do not involve fraud or misrepresentation shall be limited to a review of only those claims for which no more than 24 months have elapsed since the date of payment of the claim. Additionally, any provider overpayment identified for which 24 months or more have elapsed since the date of payment of the claim shall not be subject to repayment or to offset against future reimbursement of claims by the provider. Any improper payment identified through a review may be resubmitted by the provider as a claims adjustment.
   The bill takes effect upon enactment.