The bill amends the Medical Assistance Act to strengthen program integrity by enhancing the processes for audits and investigations related to fraud, waste, or abuse. Key provisions include requirements for program integrity contractors to provide written justifications for audits, limit claims reviews to a three-year period from payment, and issue detailed notifications regarding adverse determinations that could result in payment recoupment. Additionally, it mandates the use of licensed healthcare professionals in establishing audit methodologies and allows providers to submit records electronically. The bill also requires the Department of Medicaid and Long-Term Care to submit an annual report to the Legislature on program integrity contracts and clarifies providers' rights to appeal adverse determinations while establishing a process for informal consultations before final decisions.

Furthermore, the bill modifies sections of the Reissue Revised Statutes of Nebraska, particularly concerning the Ground Emergency Medical Transport Act and the Medicaid Managed Care program. It defines fraud according to federal or state law, introduces a fraud hotline tip, and clarifies terms related to program integrity audits. The calculation of supplemental reimbursements for eligible providers is adjusted to ensure they do not exceed federal financial participation and can be based on actual and allowable costs. The bill also outlines the responsibilities of governmental entities in seeking supplemental reimbursement, including expenditure certification and record maintenance for federal compliance. It establishes the Medicaid Managed Care Excess Profit Fund to address health needs and improve services, while ensuring contractor compliance with laws regarding mental health and substance use disorder services. Overall, the bill aims to enhance the integrity and efficiency of the Medicaid program while ensuring adequate service delivery to beneficiaries.

Statutes affected:
Introduced: 68-995, 68-996
Final Reading: 68-974, 68-982, 68-985, 68-986, 68-987, 68-988, 68-995, 68-996
Slip Law: 68-974, 68-982, 68-985, 68-986, 68-987, 68-988, 68-995, 68-996