CA AB2034

Requires the State Department of Health Care Services to revise the Medicaid state plan by January 1, 2024 to establish a revised audit process for LEA Medi-Cal Billing Option claims, with fraud, waste, and abuse as the primary focus of recoupment.

Mandates audit completion and notification of findings within 12 months of Cost and Reimbursement Comparison Schedule submission, with final settlement within three years, and appeals of audits disallowing 50% or more of claims completed within 180 days.

Requires the department to provide technical assistance and corrective action plans to LEAs when audits disallow more than 25% of their total claim value in a given year.

Prohibits auditors from disallowing claims for services meeting regulatory requirements unless they are out of compliance with the LEA program guide or state plan in effect at time of submission.

Requires annual legislative reports including training provided to LEAs, number of audits conducted, funds disallowed broken down by cause, and technical assistance efforts provided.