CT HB07009

Revises Medicaid audit requirements for service providers effective July 1, 2017, requiring audits to follow statistically valid sampling and extrapolation methodology validated by a statistician with a 95% confidence level or greater.

Requires the Commissioner of Social Services to provide written notification at least 30 days before audit commencement, disclose assigned auditor information, and limit audits to claims paid within 36 months of selection; prohibits applying policies or guidelines to audits unless previously distributed to the provider.

Establishes that overpayment findings based on extrapolation shall only apply when the extrapolated amount exceeds 1.75% of total claims paid during the audit period, and requires providers receive at least 30 days to provide documentation and evidence of errors.

Mandates preliminary audit reports within 60 days of audit conclusion, exit conferences to discuss findings, and final reports within 60 days of the exit conference; allows providers to request a contested case hearing within 30 days of the final report.

Creates temporary waivers prohibiting the department from withholding payments, assessing penalties, or extrapolating overpayments for electronic visit verification implementation errors for nonmedical home care providers (January 1 to May 1, 2017) and medical home health care providers (April 1 to August 1, 2017).