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Bill > HF808
IA HF808
IA HF808A bill for an act relating to managed care organization chargebacks and third-party auditors.
summary
Introduced
03/06/2025
03/06/2025
In Committee
03/06/2025
03/06/2025
Crossed Over
Passed
Dead
Introduced Session
91st General Assembly
Bill Summary
This bill requires a managed care organization (MCO) acting pursuant to a contract with the department of health and human services to administer the medical assistance program to issue a chargeback to a provider within 12 months from the date the MCO provided reimbursement to the provider. The bill requires an MCO to negotiate a fee with a third-party auditor (auditor) prior to the auditor initiating an audit of a provider. An MCO shall not base compensation for an auditor on the percentage of chargebacks identified by the auditor.
AI Summary
This bill addresses regulations for managed care organizations (MCOs) that administer medical assistance programs in Iowa, focusing on two key provisions. First, the bill limits the timeframe for MCOs to issue chargebacks (financial recoveries from healthcare providers) to within 12 months of the original reimbursement, preventing providers from being subject to financial recoupment long after services are rendered. Second, the bill requires MCOs to negotiate a predetermined fee with third-party auditors before they can conduct provider audits, and prohibits compensating these auditors based on a percentage of chargebacks they identify. These provisions aim to protect healthcare providers from potentially prolonged or punitive financial reviews and prevent incentivizing auditors to find excessive billing discrepancies. By establishing clear guidelines for financial reviews and recoveries, the bill seeks to create more transparency and fairness in the medical assistance program's financial interactions between MCOs, providers, and third-party auditors.
Committee Categories
Business and Industry
Sponsors (1)
Last Action
Introduced, referred to Commerce. H.J. 539. (on 03/06/2025)
Official Document
bill text
bill summary
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bill summary
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bill summary
| Document Type | Source Location |
|---|---|
| State Bill Page | https://www.legis.iowa.gov/legislation/BillBook?ga=91&ba=HF808 |
| BillText | https://www.legis.iowa.gov/docs/publications/LGI/91/attachments/HF808.html |
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