CT HB05500

Requires 30 days advance written notice to Medicaid providers before audits begin, unless there is risk to recipient health/safety or suspected vendor fraud.

Prohibits using extrapolation to determine overpayments or underpayments unless there is sustained/high level of payment error, failed educational intervention, or claims exceed $200,000 annually.

Mandates preliminary audit reports within 60 days of audit conclusion, exit conferences where providers can present refuting evidence, and final reports within 60 days of the exit conference.

Allows providers 30 days to provide documentation for any discrepancies and permits appeals of final audit decisions to Superior Court; establishes binding arbitration process for facilities subject to section 17b-99a.

Requires Commissioner to adopt regulations on audit procedures, provide free training to providers on claims entry and cost reporting, and establish audit protocols by February 1, 2015 (February 15, 2015 for facilities) for specific service categories.