CO SB314

Establishes comprehensive requirements for Colorado's Medicaid Recovery Audit Contractor (RAC) program, including definitions for automated audits (coding rule reviews) and complex audits (requiring medical record submission)

Caps RAC vendor contingency fees at 16% of recovered payments and requires tiered payment structures in future contracts based on work required

Limits complex audits to 3 per provider per year and sets maximum monthly medical record requests for hospitals based on Medicaid revenue tiers (ranging from 600 for hospitals with over $250 million to 10 for out-of-state facilities)

Creates a formal dispute resolution process including exit conferences, informal reconsideration meetings, and formal appeals, with the state department prohibited from recovering overpayments until all processes are complete

Establishes the Recovery Audit Contractor Recoveries Cash Fund and adjusts appropriations by shifting $20,900,588 from recoveries and recoupments to the new fund