Amendments for SB25-314
Senate Journal, April 29
After consideration on the merits, the Committee recommends that SB25-314 be amended
as follows, and as so amended, be referred to the Committee of the Whole with favorable
recommendation.
Amend printed bill, page 19, line 14, after "FUND." insert "SUBJECT TO ANNUAL
APPROPRIATION BY THE GENERAL ASSEMBLY, THE STATE DEPARTMENT MAY
EXPEND MONEY FROM THE CASH FUND TO OFFSET THE NEED FOR
APPROPRIATIONS FOR MEDICAL SERVICES AND TO PAY THE RAC VENDOR.".
Appro-
priations
Senate Journal, April 29
SB25-314 by Senator(s) Kirkmeyer and Bridges, Amabile; also Representative(s) Bird and Sirota,
Taggart--Concerning changes to the recovery audit contractor program, and, in connection
therewith, making and reducing an appropriation.
Amendment No. 1, Appropriations Committee Amendment.
(Printed in Senate Journal, April 29, page(s) 1157 and placed in members' bill files.)
Amendment No. 2(L.002), by Senator Kirkmeyer.
Amend printed bill, page 5, strike lines 20 through 24 and substitute:
"(E) PROVIDE PRELIMINARY RAC AUDIT FINDINGS TO A PROVIDER
WITHIN A REASONABLE PERIOD FOLLOWING RECEIPT OF ANY REQUESTED
MEDICAL RECORDS, AS DETERMINED BY THE STATE DEPARTMENT IN
COLLABORATION WITH THE PROVIDER ADVISORY GROUP, CREATED IN
SUBSECTION (3.5)(c)(I) OF THIS SECTION.".
Page 12, strike lines 9 through 27.
Strike pages 13 and 14.
Page 15, strike lines 1 through 20 and substitute:
"(l) (I) IF THE RAC VENDOR IDENTIFIES PRELIMINARY FINDINGS DURING
THE RAC AUDIT, THE RAC VENDOR MUST SEND THE PROVIDER A NOTICE OF
PRELIMINARY AUDIT FINDINGS DETAILING THE PRELIMINARY FINDINGS, THE
RATIONALE FOR THE PRELIMINARY FINDINGS, AND THE METHODOLOGY FOR HOW
THE DOLLAR AMOUNTS ASSOCIATED WITH THE PRELIMINARY FINDINGS WERE
CALCULATED AND DETERMINED.
(II) FOR A COMPLEX AUDIT, A PROVIDER MAY REQUEST AN EXIT
CONFERENCE TO DISCUSS THE PRELIMINARY FINDINGS WITH THE RAC VENDOR
AND THE STATE DEPARTMENT MEDICAL DIRECTOR, OR THE STATE DEPARTMENT
MEDICAL DIRECTOR'S DESIGNEE, PRIOR TO PARTICIPATING IN AN INFORMAL
RECONSIDERATION. THE PROVIDER MAY PROVIDE ADDITIONAL INFORMATION
SUPPORTING THE PROVIDER'S CLAIMS AT THE EXIT CONFERENCE. A PROVIDER
MUST REQUEST AN EXIT CONFERENCE NO LATER THAN THIRTY DAYS AFTER THE
PROVIDER RECEIVES A NOTICE OF PRELIMINARY AUDIT FINDINGS FROM THE RAC
VENDOR, AND IF AN EXIT CONFERENCE IS REQUESTED, THE STATE DEPARTMENT
OR THE RAC VENDOR MUST SCHEDULE THE EXIT CONFERENCE WITHIN SIXTY
DAYS OF RECEIVING THE REQUEST AND ON A MUTUALLY AGREED UPON DATE
AND TIME.
(III) WITHIN THIRTY DAYS OF THE EXIT CONFERENCE, THE STATE
DEPARTMENT MUST NOTIFY THE PROVIDER ON WHETHER THE STATE
DEPARTMENT WILL DISMISS THE PRELIMINARY FINDINGS OR WILL ISSUE A NOTICE
OF INFORMAL RECONSIDERATION. THE NOTICE OF INFORMAL RECONSIDERATION
MUST INCLUDE DETAILS ON THE PRELIMINARY FINDINGS, THE RATIONALE FOR
THE PRELIMINARY FINDINGS, AND THE METHODOLOGY FOR HOW THE DOLLAR
AMOUNT ASSOCIATED WITH THE PRELIMINARY FINDINGS WERE CALCULATED
AND DETERMINED. IF AN EXIT CONFERENCE OCCURRED, THE NOTICE MUST
INCLUDE INFORMATION ON WHY THE STATE DEPARTMENT DID NOT AGREE WITH
THE PROVIDER'S APPROACH.
(IV) UNLESS THE PRELIMINARY FINDINGS ARE ACCEPTED BY THE
PROVIDER, DISMISSED BY THE STATE DEPARTMENT FOLLOWING AN EXIT
CONFERENCE, OR THE PERIOD FOR A PROVIDER TO REQUEST AN EXIT
CONFERENCE HAS EXPIRED, A PROVIDER WHO RECEIVES A NOTICE OF
PRELIMINARY FINDINGS, THE STATE DEPARTMENT, AND THE RAC VENDOR MUST
PARTICIPATE IN AN INFORMAL RECONSIDERATION BEFORE THE PROVIDER MAY
FORMALLY APPEAL THE STATE DEPARTMENT'S DETERMINATION. TO
PARTICIPATE IN AN INFORMAL CONSIDERATION, THE FOLLOWING REQUIREMENTS
MUST BE SATISFIED:
(A) WITHIN SIXTY DAYS OF RECEIVING THE NOTICE OF INFORMAL
RECONSIDERATION, THE PROVIDER MUST SUBMIT ALL MEDICAL RECORDS
RELEVANT TO THE CLAIMS AND THE REASONING FOR THE PROVIDER'S
DISAGREEMENT CONCERNING THE PRELIMINARY AUDIT FINDINGS. THE MEDICAL
RECORDS MUST SUBSTANTIATE THE PROVIDER'S ARGUMENT TO DISPUTE ANY
PRELIMINARY FINDINGS TO ALLOW THE STATE DEPARTMENT AND THE RAC
VENDOR TO RECONSIDER THE FINDINGS, AND THE DEPARTMENT AND THE RAC
VENDOR MUST REVIEW MEDICAL RECORDS PRIOR TO THE INFORMAL
RECONSIDERATION MEETING;
(B) THE STATE DEPARTMENT MUST SCHEDULE AN INFORMAL
RECONSIDERATION MEETING BETWEEN MUTUALLY AGREED UPON PARTICIPANTS
FROM THE STATE DEPARTMENT, RAC VENDOR, AND PROVIDER
REPRESENTATIVES AT A MUTUALLY AGREED UPON DATE AND TIME WITHIN
NINETY DAYS OF ISSUING THE NOTICE OF INFORMAL RECONSIDERATION,
ALTHOUGH EITHER PARTY MAY REQUEST A SIXTY-DAY EXTENSION; AND
(C) ALL AGREED UPON ATTENDEES MUST PARTICIPATE IN THE
INFORMAL RECONSIDERATION MEETING IN GOOD FAITH IN AN EFFORT TO
RESOLVE THE DISPUTE.
(V) IF A CLAIM REMAINS IN DISPUTE AFTER THE INFORMAL
RECONSIDERATION MEETING, THE STATE DEPARTMENT MUST ISSUE A NOTICE OF
ADVERSE ACTION WITHIN SIXTY DAYS OF THE INFORMAL RECONSIDERATION
MEETING. THE NOTICE OF ADVERSE ACTION MUST INCLUDE THE BASIS OF THE
ALLEGED OVERPAYMENT, THE RATIONALE FOR THE ALLEGED OVERPAYMENT,
THE METHODOLOGY USED TO CALCULATE THE ALLEGED OVERPAYMENT, AND
INFORMATION ON WHY THE STATE DEPARTMENT DID NOT AGREE WITH THE
PROVIDER'S APPROACH.
(VI) WITHIN THIRTY DAYS OF RECEIVING A NOTICE OF ADVERSE ACTION,
THE PROVIDER MAY REQUEST A FORMAL APPEAL, WHICH MUST INCLUDE AN
EXPLANATION OF THE BASIS OF THE APPEAL IN ACCORDANCE WITH RULES
ADOPTED BY THE STATE DEPARTMENT.
(VII) THE STATE DEPARTMENT MUST NOT RECOVER AN OVERPAYMENT
IDENTIFIED IN THE PRELIMINARY FINDINGS FROM A PROVIDER UNTIL THE
INFORMAL RECONSIDERATION PROCESS, AND SUBSEQUENT FORMAL APPEAL, IF
FILED, ARE COMPLETE.
(VIII) IF THE STATE DEPARTMENT HAS NOT ISSUED A NOTICE OF
ADVERSE ACTION ONE HUNDRED TWENTY DAYS FOLLOWING THE INFORMAL
RECONSIDERATION MEETING, THE STATE DEPARTMENT WAIVES ITS RIGHT TO
RECOVER THE STATE SHARE OF THE OVERPAYMENT.".
Reletter succeeding paragraphs accordingly.
Page 16, line 27, strike "(3.3)(o)(I)" and substitute "(3.3)(n)(I)".
Page 19, line 11, strike "(3.3)(t)" and substitute "(3.3)(s)".
Page 19, line 27, strike "(3.3)(m)" and substitute "(3.3)(n)".
Page 20, line 23, strike "(3.3)(t)," and substitute "(3.3)(s),".
As amended, ordered engrossed and placed on the calendar for third reading and final
passage.