This bill amends section 68-974 of the Revised Statutes Cumulative Supplement, 2024, to strengthen the Medical Assistance Act by implementing clearer requirements for program integrity contractors and recovery audit contractors. Key provisions include a mandate for contractors to provide written justification prior to initiating an audit, a reduction of the claims review period from four years to one year, and a stipulation that payment adjustments cannot occur after one year unless fraud is involved. Additionally, the bill requires contractors to deliver detailed notifications regarding adverse determinations, including information on overpayments and the appeals process, thereby enhancing transparency and accountability.

The bill also introduces new definitions and clarifications related to fraud and program integrity, defining terms such as "allegations," "fraud," and "fraud hotline tip." It emphasizes the importance of an informal consultation process before final determinations are made and allows providers to submit records electronically. Furthermore, the bill mandates annual reporting by the department on the status of contracts related to program integrity, including cost recovery and savings. In terms of deletions, the bill removes outdated definitions and sections, replacing them with updated language to reflect the new framework governing these issues, thereby improving the efficiency and fairness of the audit process while ensuring that providers are well-informed and supported.

Statutes affected:
Introduced: 68-974