SB 367-FN – AS AMENDED BY THE SENATE
03/22/06 1414s
03/22/06 1518s
2006 SESSION
05/01
SENATE BILL 367-FN
AN ACT imposing a penalty on Medicaid providers who receive overpayments of state Medicaid funds.
SPONSORS: Sen. Martel, Dist 18; Sen. Morse, Dist 22; Sen. Johnson, Dist 2; Sen. Clegg, Dist 14; Sen. Letourneau, Dist 19; Rep. Pilotte, Hills 16; Rep. G. Katsakiores, Rock 5; Rep. P. Katsakiores, Rock 5
COMMITTEE: Health and Human Services
This bill:
I. Permits the department of health and human services to impose an administrative penalty on Medicaid providers for overpayments.
II. Extends the appropriation to the department of health and human services for supplemental pharmacy assistance during the period of transition to the new federal pharmacy benefit under Part D of the Medicare program.
This bill is a request of the department of health and human services.
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Explanation: Matter added to current law appears in bold italics.
Matter removed from current law appears [in brackets and struckthrough.]
Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
03/22/06 1414s
03/22/06 1518s
06-2672
05/01
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Six
AN ACT imposing a penalty on Medicaid providers who receive overpayments of state Medicaid funds.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 New Section; Surveillance and Utilization Review Program; Administrative Penalties. Amend RSA 167 by inserting after section 60 the following new section:
167:60-a Surveillance and Utilization Review Program; Administrative Penalty.
I. The department shall establish and maintain, pursuant to 42 C.F.R. section 456.3, a statewide surveillance and utilization review program to assess the quality of services provided under the state Medicaid program, to monitor compliance with state and federal Medicaid regulations, and to ensure accurate and proper reimbursement to Medicaid providers. To facilitate the surveillance and utilization review program, Medicaid providers shall maintain records for covered goods or services according to the requirements established by the department.
II. In conducting the review under paragraph I, the department may impose the following administrative penalty upon any Medicaid provider who, after notice of overpayments and identification of claims resulting in the overpayments, has violated the requirements of the Medicaid rules because the provider lacks proof or records that the goods or services were provided for covered goods or services: a penalty of up to 100 percent of Medicaid payments for goods or services, if the provider fails to demonstrate that the disputed goods or services were medically necessary, were covered goods or services, and were actually provided to eligible recipients.
III. The department shall adopt rules, pursuant to RSA 541-A as necessary to carry out the provisions of this section.
2 Appropriation; Supplemental Pharmacy Assistance. Amend 2006, 2:2 to read as follows:
2:2 Appropriation; Supplemental Pharmacy Assistance. Up to the sum of $500,000 for the [fiscal year] biennium ending June 30, [2006] 2007 is hereby appropriated to the department of health and human services, for the purpose of providing supplemental pharmacy assistance. The governor is authorized to draw a warrant for said sum out of any money in the treasury not otherwise appropriated. If the commissioner determines additional funds are needed to provide the supplemental pharmacy assistance the commissioner, with the approval of the legislative fiscal committee, may expend other funds appropriated to the department for this purpose.
3 Effective Date. This act shall take effect upon its passage.
LBAO
06-2672
Amended 4/5/06
SB 367 FISCAL NOTE
AN ACT imposing a penalty on Medicaid providers who receive overpayments of state Medicaid funds.
FISCAL IMPACT:
The Department of Health and Human Services states this bill, as amended by the Senate, (Amendment #’s2006-1414s and 2006-1518s), will increase state general fund revenue by an indeterminable amount in FY 2007 and each year thereafter and increase state general fund expenditures by an indeterminable amount in FY 2007. There will be no fiscal impact on county and local revenue or expenditures.
METHODOLOGY:
The Department of Health and Human Services (DHHS) states they pursue recovery of Medicaid related overpayments from providers through the efforts of the Surveillance & Utilization Review Sub System (SURS) Unit. This bill grants DHHS the discretion to apply a penalty of up to 100% of the original amount of the claim, which in practice, would be applied by DHHS staff based upon the amount of administrative time and effort expended by the Department in order to validate the integrity of the original claim. Of any amounts recovered, half would be deposited into the state general fund and half would be sent to the federal government. The Department states they cannot adequately speculate as to what provider claims may be considered in non-compliance with Medicaid rules and regulations, and therefore are unable to determine the exact revenue impact at this time.
This bill also extends the $500,000 general fund appropriation contained in Chapter 2, Laws of 2006, for supplemental pharmacy assistance during the period of transition to the federal pharmacy benefit under Medicare Part D through the biennium ending June 30, 2007. To the extent funds that would not have been spent in FY 2006 will be spent in FY 2007, this bill will increase state expenditures by an indeterminable amount.