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, the bill mandates the use of licensed healthcare professionals for audit methodologies and allows providers to submit records electronically. It also introduces protective measures for providers during audits, such as requiring advance notice for onsite audits and prohibiting recoupment of overpayments until all appeals are resolved, unless credible evidence of fraud is present.

Furthermore, the bill modifies several sections of the Reissue Revised Statutes of Nebraska, particularly concerning the Ground Emergency Medical Transport Act and the Medicaid Managed Care program. It clarifies the definition of fraud, introduces a fraud hotline, and refines terms related to program integrity audits. The bill also establishes the Medicaid Managed Care Excess Profit Fund to offset losses and ensure compliance with mental health and substance use disorder service laws. The Division of Medicaid and Long-Term Care is assigned responsibilities to enhance contractor compliance and maintain service provider network adequacy. Overall, these amendments aim to improve the integrity and efficiency of the medical assistance program while ensuring better 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