House Bill No. 7105 seeks to amend Section 17b-99a of the general statutes to enhance the process of forensic audits conducted by the Department of Social Services (DSS). The bill introduces the definition of "forensic audit" and expands the scope of facilities subject to these audits to include chronic and convalescent nursing homes and residential facilities for individuals with intellectual disabilities. It mandates that the Commissioner of Social Services provide written notification to facilities at least thirty days prior to an audit, except in cases involving health or safety concerns or evidence of vendor fraud. The bill also outlines the audit process, requiring preliminary and final reports, exit conferences, and the opportunity for facilities to contest findings. It establishes criteria for determining overpayments or underpayments and prohibits the use of extrapolation unless specific conditions are met.

Additionally, the bill imposes civil monetary penalties for non-compliance with audit requests, allowing for penalties of up to $1,000 per day and capping audit costs at $100,000, which can be recouped through reduced Medicaid payments. Facilities are required to cooperate with audits and provide necessary assistance within ten business days of a request from DSS. The bill also allows facilities to request a fair hearing regarding any penalties assessed. Overall, HB7105 aims to improve financial oversight and compliance within Medicaid-funded facilities while ensuring that they are adequately informed and supported throughout the auditing process.

Statutes affected:
Raised Bill:
HS Joint Favorable:
File No. 468: