Bill > LB381

This bill modifies the requirements for program integrity audits under the Medical Assistance Act, introducing several key changes to protect healthcare providers during audit processes. The bill reduces the audit review period from four years to one year, mandates that program integrity contractors provide clear written justification for commencing an audit, and requires detailed written notifications for adverse determinations. Contractors must now schedule onsite audits with at least ten days' advance notice, use licensed healthcare professionals from the relevant specialty to establish audit methodology, and limit record requests to 200 records per 180-day period. The bill also establishes new protections for providers, such as preventing recovery of payments for services with prior authorization, limiting overpayment recoveries, and creating a more structured appeal process. Additionally, the bill defines key terms like "fraud," "clerical error," and "credible allegation of fraud," and requires annual reporting to the Legislature about audit contracts, their estimated cost recovery, and savings. The goal is to create a more transparent, fair, and provider-friendly audit process while maintaining the integrity of the medical assistance program.

Health and Social Services

https://nebraskalegislature.gov/bills/view_bill.php?DocumentID=59059