Bill > A01069

This bill requires the Medicaid Inspector General to adhere to specific standards when auditing and reviewing funds for the medical assistance program, which is a government program providing healthcare to low-income individuals. The bill defines "overpayment" as any amount improperly paid under the program, "applicable standards" as the relevant state laws, regulations, and policies in effect at the time of service, and "clerical or minor error or omission" to include mistakes like mathematical errors or incorrect data entry. It mandates that audits and reviews must follow these applicable standards, and the Inspector General must provide providers with access to these standards beforehand and publish audit protocols on their website. When determining repayment amounts for overpayments, the Inspector General must consider factors such as the level of error, whether the error was minor, the provider's financial stability, and the potential impact on patient access to care. The bill also specifies that sampling and extrapolation methods used in audits must be statistically sound, and if an overpayment stems from a limited number of minor errors, extrapolation will not be applied, and recoupment will be limited to those specific claims. Furthermore, draft audit reports must detail any extrapolation methods used, and providers can submit supporting documentation, including attestations, which the Inspector General must consider. The bill also requires the Inspector General to explain how the aforementioned factors were considered in their final reports and clarifies that providers can still settle overpayments before a hearing determination. Finally, it sets a minimum timeframe of sixty days after a final audit report or hearing determination before recoupment or repayment can begin, while ensuring compliance with federal Medicaid audit requirements.