Bill Text: GA HB489 | 2011-2012 | Regular Session | Comm Sub
Bill Title: Medicaid audits; contingency fee audits; prohibit
Spectrum: Partisan Bill (Republican 2-0)
Status: (Vetoed) 2011-05-13 - Veto V8 [HB489 Detail]
Download: Georgia-2011-HB489-Comm_Sub.html
11 LC
33 4209ERS
The
Senate Health and Human Services Committee offered the following substitute to
HB 489:
A
BILL TO BE ENTITLED
AN ACT
AN ACT
To
amend Article 7 of Chapter 4 of Title 49 of the Official Code of Georgia
Annotated, relating to medical assistance generally, so as to prohibit
contingency fee contracts for purposes of conducting investigations and audits
for Medicaid recovery; to provide for related matters; to repeal conflicting
laws; and for other purposes.
BE
IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:
SECTION
1.
Article
7 of Chapter 4 of Title 49 of the Official Code of Georgia Annotated, relating
to medical assistance generally, is amended by adding a new Code section to read
as follows:
"49-4-151.1.
On
and after July 1, 2011, the department shall not enter into any contract with a
Medicaid recovery audit contractor, as identified in 19 U.S.C. 1902 (a)(42)(B),
for the purpose of identifying underpayments and overpayments and recovering
overpayments under the state plan or any waiver of the state plan when the basis
of payment by the department is contingent upon a percentage of the overpayment
amounts collected by the contractor. This Code section shall not apply to any
such contingency fee contract entered into prior to July 1, 2011. Nothing in
this Code section shall be construed to require the department to enter into any
contract which would violate any federal law, rule, regulation, directive, or
policy. Additionally, this Code section shall apply only to such Medicaid
recovery audit contracts described herein. This Code section shall not apply to
any other department contract, including, but not limited to, any contingency
fee third-party liability recovery contract, estate recovery contract, state
program integrity contract, or any other agency contract, lease, agreement, or
other transaction entered into for the purposes of conducting investigations,
utilization reviews, audits, or for any other departmental purpose. Pursuant to
Title XIX of the federal Social Security Act, as amended by the federal Patient
Protection and Affordable Care Act, the Centers for Medicaid & Medicare
Services may issue a waiver that exempts a state from the federal requirement to
pay Medicaid recovery audit contractors on a contingent fee basis when state law
expressly prohibits such contingency fee contracting. The department shall seek
such a waiver through the submission of a state plan
amendment."
SECTION
2.
All
laws and parts of laws in conflict with this Act are repealed.