HF2142: Medicaid Post-Payment Review

Restricts the timeframe for post-payment audits of Medicaid provider claims to within 12 months of payment, unless fraud or misrepresentation is involved. Claims identified as overpayments after 12 months will not require repayment or offset. The bill excludes retroactive cost settlements and allows providers to resubmit claims as adjustments. The legislation becomes effective immediately upon enactment.

Key Points & Impacts:

• Limits post-payment review of Medicaid claims to those paid within the last 12 months, unless fraud or misrepresentation is involved.

• Prohibits repayment or offset for provider overpayments identified more than 12 months after claim payment.

• Excludes retroactive Medicaid cost settlements or rate changes based on cost reports from these limitations.

• Allows providers to resubmit claims as adjustments if improper payments are identified during review.

• Applies to both Medicaid fee-for-service and managed care claims.

• Overrides any contrary provisions of current law regarding post-payment review timeframes.

• Aims to provide greater certainty and financial protection for Medicaid providers regarding claim audits and repayments.

• The bill takes effect immediately upon enactment.