Substitute House Bill No. 5354, also known as Public Act No. 26-143, amends the existing Medicaid provider audit regulations. The bill specifically modifies subdivision (4) of subsection (d) of section 17b-99 by repealing the previous threshold for determining overpayment or underpayment based on extrapolation. The new threshold is set at two and three-quarters percent of total claims paid to the provider for the audit period, replacing the previous threshold of one percent. This change aims to provide a more stringent criterion for when extrapolation can be used in audits.

Additionally, the bill introduces new provisions that require the commissioner to provide up-to-date educational materials and technical assistance to Medicaid providers starting from audit review periods that commence on January 1, 2027. This initiative is intended to help providers understand proper Medicaid billing practices before any extrapolation is applied in audits. The changes are set to take effect on October 1, 2026.