HB 5309 Summary

• Prohibits Medicaid audit findings from using extrapolation methodology if the overpayment or underpayment results from provider clerical errors.

• Requires extrapolated overpayment findings (excluding clerical errors) to exceed 1.75% of total claims paid to a provider during the audit period before the state can base findings on extrapolation.

• Limits state cost recovery for clerical errors to the actual overpayment amount plus administrative expenses related to investigating the error.

• Applies to programs operated or administered by the department under specified chapters, except providers with rates established under section 17b-340.

• Effective July 1, 2020.