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House
File
2142
-
Introduced
HOUSE
FILE
2142
BY
GJERDE
,
WILSON
,
KRESSIG
,
AMOS
JR.
,
MATSON
,
BROWN-POWERS
,
WILBURN
,
LEVIN
,
SCHOLTEN
,
WESSEL-KROESCHELL
,
and
GOSA
A
BILL
FOR
An
Act
relating
to
limitations
on
activities
related
to
paid
1
claims
under
the
Medicaid
program,
and
including
effective
2
date
provisions.
3
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
4
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(2)
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ak/ko
H.F.
2142
Section
1.
NEW
SECTION
.
249A.42B
Limitations
on
activities
1
related
to
paid
claims
——
resubmission.
2
1.
Notwithstanding
any
provision
of
law
to
the
contrary,
3
any
post-payment
review
of
Medicaid
provider
claims
paid
under
4
either
Medicaid
fee-for-service
or
managed
care
administration
5
that
do
not
involve
fraud
or
misrepresentation
shall
be
limited
6
to
a
review
of
only
those
claims
for
which
no
more
than
twelve
7
months
have
elapsed
since
the
date
of
payment
of
the
claim.
8
2.
Additionally,
any
provider
overpayment
identified
for
9
which
twelve
months
or
more
have
elapsed
since
the
date
of
10
payment
of
the
claim
shall
not
be
subject
to
repayment
or
to
11
offset
against
future
reimbursement
of
claims
by
the
provider.
12
3.
The
limitations
specified
in
this
section
shall
not
apply
13
to
retroactive
Medicaid
cost
settlements
or
rate
changes
based
14
on
a
Medicaid
or
Medicare
cost
report.
15
4.
Any
improper
payment
identified
through
a
review
may
be
16
resubmitted
by
the
provider
as
a
claims
adjustment.
17
Sec.
2.
EFFECTIVE
DATE.
This
Act,
being
deemed
of
immediate
18
importance,
takes
effect
upon
enactment.
19
EXPLANATION
20
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
21
the
explanation’s
substance
by
the
members
of
the
general
assembly.
22
This
bill
relates
to
the
limitations
on
activities
related
23
to
paid
claims
under
the
Medicaid
program.
24
The
bill
provides
that
notwithstanding
any
provision
of
25
law
to
the
contrary,
any
post-payment
review
of
Medicaid
26
provider
claims
paid
under
either
Medicaid
fee-for-service
27
or
managed
care
administration
that
do
not
involve
fraud
or
28
misrepresentation
shall
be
limited
to
a
review
of
only
those
29
claims
for
which
no
more
than
12
months
have
elapsed
since
30
the
date
of
payment
of
the
claim.
Additionally,
any
provider
31
overpayment
identified
for
which
12
months
or
more
have
elapsed
32
since
the
date
of
payment
of
the
claim
shall
not
be
subject
33
to
repayment
or
to
offset
against
future
reimbursement
of
34
claims
by
the
provider.
Any
improper
payment
identified
35
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H.F.
2142
through
a
review
may
be
resubmitted
by
the
provider
as
a
claims
1
adjustment.
2
The
bill
takes
effect
upon
enactment.
3
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