Medi-Cal: unrecovered payments: interest rate.

Plain English Breakdown

The bill summary and digest do not provide specific details on the conditions under which interest is waived, only that it requires consideration of certain factors.

Medi-Cal: Interest Rates for Unrecovered Payments

This law allows the Department of Health Care Services to waive interest on unrecovered overpayments under certain conditions, such as when the latest date of service or audit period end date was at least four years before the first demand for repayment.

What This Bill Does

• Allows the Department of Health Care Services to waive interest on unrecovered overpayments if specific factors are met.
• Requires consideration of factors like the impact of repayment amounts on a provider's financial stability and whether the overpayment was due to policy changes or departmental errors before waiving interest.
• Preserves the right for the department to seek legal remedies if a provider does not follow through with a repayment plan.

Who It Names or Affects

• Healthcare providers who have unrecovered overpayments in the Medi-Cal program.
• The State Department of Health Care Services, which administers the Medi-Cal program.

Terms To Know

Medi-Cal

A health care program for low-income Californians funded by both federal and state governments.

Unrecovered overpayment

Money that a healthcare provider has received from Medi-Cal but should not have, which the department is trying to recover.

Limits and Unknowns

• The bill does not specify when it will take effect.
• It only applies to unrecovered payments where the latest date of service or audit period end date was at least four years before the first demand for repayment was issued.

Official Summary Text

AB 676, as amended, Jeff Gonzalez.
Medi-Cal: unrecovered payments: interest rate.
Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.
Existing law requires the Director of Health Care Services to establish administrative appeal processes to review grievances or complaints arising from the findings of an audit or examination. Under existing law, if recovery of a disallowed payment has been made by the department, a provider who prevails in an appeal of that payment is entitled to interest at the rate equal to the monthly average received on investments in the Surplus Money Investment Fund, or simple interest at the rate of 7% per annum, whichever is higher. Under existing law, with
exceptions, interest at that same rate is assessed against any unrecovered overpayment due to the department.
In the case of an assessment against any unrecovered overpayment due to the department, this bill would
authorize
require
the department to waive the interest, as part of a repayment agreement entered into with the provider, if
the latest date of service for a retroactive payment adjustment or audit period end date for
the unrecovered overpayment occurred 4 or more years before the issuance of the first statement of account status or demand for repayment,
after taking into account specified factors.
and the department determines that certain factors apply.
Under the bill, those factors would include, among others, the impact of the repayment amounts on the fiscal solvency of the provider, and whether the overpayment was caused by a policy change or departmental error that was not
the fault of
caused by
the billing provider.
The bill would preserve the rights of the department to seek all remedies available at law if a provider defaults on a repayment plan. This bill would authorize the department to implement, interpret, or make specific these provisions, in whole or in part, by means of information notices, all-county letters, or other similar instructions without taking regulatory action.

Current Bill Text

Download Bill PDF