Session Law 2011-399 (Senate Bill 496) Summary

• Establishes Chapter 108C governing Medicaid and Health Choice provider requirements, including provider screening, enrollment criteria, and audit procedures.

• Creates three risk-level categories for provider screening (limited, moderate, high) with specified provider types assigned to each level, determining the scope of screening required by federal law.

• Authorizes the Department to conduct criminal history checks and deny or terminate provider enrollment for convictions related to Medicare, Medicaid, or Health Choice programs within 10 years, or for disqualifying criminal offenses.

• Establishes procedures for payment suspension, audit extrapolation, prepayment claims review, and provider appeals through contested case proceedings, with the Department bearing the burden of proof.

• Requires provider enrollment attestation and mandatory training on Medicaid billing, audit procedures, fraud identification, and reporting before initial enrollment, with online training available through the Department's website.