House File 2142 - Introduced HOUSE FILE 2142 BY GJERDE , WILSON , KRESSIG , AMOS JR. , MATSON , BROWN-POWERS , WILBURN , LEVIN , SCHOLTEN , WESSEL-KROESCHELL , and GOSA A BILL FOR An Act relating to limitations on activities related to paid 1 claims under the Medicaid program, and including effective 2 date provisions. 3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 4 TLSB 5655YH (2) 91 ak/ko

H.F. 2142 Section 1. NEW SECTION . 249A.42B Limitations on activities 1 related to paid claims —— resubmission. 2 1. Notwithstanding any provision of law to the contrary, 3 any post-payment review of Medicaid provider claims paid under 4 either Medicaid fee-for-service or managed care administration 5 that do not involve fraud or misrepresentation shall be limited 6 to a review of only those claims for which no more than twelve 7 months have elapsed since the date of payment of the claim. 8 2. Additionally, any provider overpayment identified for 9 which twelve months or more have elapsed since the date of 10 payment of the claim shall not be subject to repayment or to 11 offset against future reimbursement of claims by the provider. 12 3. The limitations specified in this section shall not apply 13 to retroactive Medicaid cost settlements or rate changes based 14 on a Medicaid or Medicare cost report. 15 4. Any improper payment identified through a review may be 16 resubmitted by the provider as a claims adjustment. 17 Sec. 2. EFFECTIVE DATE. This Act, being deemed of immediate 18 importance, takes effect upon enactment. 19 EXPLANATION 20 The inclusion of this explanation does not constitute agreement with 21 the explanation’s substance by the members of the general assembly. 22 This bill relates to the limitations on activities related 23 to paid claims under the Medicaid program. 24 The bill provides that notwithstanding any provision of 25 law to the contrary, any post-payment review of Medicaid 26 provider claims paid under either Medicaid fee-for-service 27 or managed care administration that do not involve fraud or 28 misrepresentation shall be limited to a review of only those 29 claims for which no more than 12 months have elapsed since 30 the date of payment of the claim. Additionally, any provider 31 overpayment identified for which 12 months or more have elapsed 32 since the date of payment of the claim shall not be subject 33 to repayment or to offset against future reimbursement of 34 claims by the provider. Any improper payment identified 35 -1- LSB 5655YH (2) 91 ak/ko 1/ 2

H.F. 2142 through a review may be resubmitted by the provider as a claims 1 adjustment. 2 The bill takes effect upon enactment. 3 -2- LSB 5655YH (2) 91 ak/ko 2/ 2