HB 1091 - Medicaid Provider Accountability Summary

• Requires background screening of all persons providing personal care under the consumer-directed care program, with exemptions for those screened within 90 days who attest to no disqualifying convictions since screening.

• Extends medical and Medicaid-related record retention requirements from 5 to 6 years and mandates providers report changes in ownership or principals to the agency within 30 days.

• Authorizes agency onsite inspections before entering provider agreements and removes exemptions for certain licensed providers and waiver programs from inspection requirements.

• Establishes that overpayment determinations must be based solely on information available before audit report issuance and eliminates the requirement to pay interest on withheld payments when fraud, abuse, or misrepresentation is not substantiated.

• Requires providers to reimburse overpayments and fines within 30 days of final order and mandates agency termination of provider participation if payment is not made, and expands immunity protections for fraud whistleblowers to include abuse and overpayment reports.