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 three years from payment, and issue detailed notifications for adverse determinations that could lead to payment recoupment. It also mandates the use of licensed healthcare professionals in audit methodologies and allows for electronic submission of records by providers. Additionally, the bill requires the Department of Medicaid and Long-Term Care to submit an annual report to the Legislature on program integrity contracts and establishes a clearer appeals process for providers, ensuring that no overpayments are recouped until all appeals are resolved, barring credible evidence of fraud.

Furthermore, the bill revises 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, and clarifies terms related to audits and reimbursement structures. The bill also outlines the responsibilities of governmental entities in seeking supplemental reimbursement, including the certification of claimed expenditures. It establishes the Medicaid Managed Care Excess Profit Fund to address health needs for adults and children under the Medical Assistance Act and tasks the Division of Medicaid and Long-Term Care with ensuring compliance with mental health and substance use disorder service regulations, while promoting transparency through public reporting of audits and financial analyses.

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