Bill Text: CT HB05500 | 2014 | General Assembly | Introduced
Bill Title: An Act Concerning Provider Audits Under The Medicaid Program.
Spectrum: Bipartisan Bill
Status: (Passed) 2014-06-11 - Signed by the Governor [HB05500 Detail]
Download: Connecticut-2014-HB05500-Introduced.html
General Assembly |
Raised Bill No. 5500 | ||
February Session, 2014 |
LCO No. 2149 | ||
*02149_______HS_* | |||
Referred to Committee on HUMAN SERVICES |
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Introduced by: |
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(HS) |
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AN ACT CONCERNING PROVIDER AUDITS UNDER THE MEDICAID PROGRAM.
Be it enacted by the Senate and House of Representatives in General Assembly convened:
Section 1. (NEW) (Effective July 1, 2014) (a) As used in this section:
(1) "Extrapolation" means the practice of inferring a frequency of dollar amount of overpayments, underpayments, nonvalid claims or other errors on any portion of claims submitted, based on the frequency or dollar amount of overpayments, underpayments, nonvalid claims or other errors actually measured in a sample of claims.
(2) "Provider" has the same meaning as provided in section 17b-99 of the general statutes.
(3) "Provider audit" means an audit, conducted by or on behalf of the state Department of Social Services, of a provider who receives payments from the state Medicaid program for providing goods or services.
(b) The Department of Social Services shall provide information concerning the provider audit process to providers enrolled in the Medicaid program, including, but not limited to, providing free training for new providers on how to enter claims to avoid clerical errors.
(c) The Department of Social Services, or a contractor acting on behalf of the department, shall have access during a provider audit only to information relevant to the audit, including, but not limited to, information concerning: (1) Services provided and billed to the Medicaid program during the time period covered by the audit, (2) medical necessity of such services and goods provided, and (3) whether the provider billed responsible third parties for such services or goods provided. Nothing in this subsection shall be construed to authorize access to any information that is confidential or prohibited from disclosure by law.
(d) The Department of Social Services, or a contractor acting on its behalf, shall only perform an extrapolation of claims based on a sample of like claims and shall not perform such extrapolation based on the entire number of claims billed by any one provider. In determining which providers shall be subject to an audit, the department shall direct its efforts first to providers with a higher compliance risk based on past audits or errors.
(e) The Commissioner of Social Services shall not issue payment to a contractor performing a provider audit on the basis of the amount of overpayment by the Medicaid program to the provider as determined by the provider audit.
(f) The commissioner shall give written notice concerning an audit to a provider and issue any finding of underpayment or overpayment in accordance with the provisions of subsection (d) of section 17b-99 of the general statutes.
This act shall take effect as follows and shall amend the following sections: | ||
Section 1 |
July 1, 2014 |
New section |
Statement of Purpose:
To ensure that audits of providers who receive payments under the state Medicaid program are performed fairly and accurately.
[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not underlined.]