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2001 Session

Budget Amendments - HB1600 (Member Request)

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Chief Patron: Bloxom
Medicaid Audit Improvements (language only)

Item 316 #2h

Item 316 #2h

Health And Human Resources
Medical Assistance Services, Department of

Language
Page 306, after line 52, insert:
"E.1.  As a condition of this appropriation, the Department of Medical Assistance Services (DMAS) shall develop and implement a written plan to include procedures for audits of providers of community mental health, mental retardation, and substance abuse services furnished under the State Medical Assistance Plan conducted directly, through the Office of the Attorney General or through a contract with any other entity, pursuant to §32.1-320, Code of Virginia.  This plan shall include, but shall not be limited to, provisions to cover the following: clear and specific guidelines to providers through published manuals and memoranda pertaining to covered services and requirements for reimbursement; availability and provision of DMAS training for providers relating to covered services and requirements for reimbursement; a mechanism for providers to receive timely written answers to questions during service delivery or claims processing; a mechanism for informing providers before and during the audit process as to the specific documents to be made available for purposes of the audit; the alternative use of reasonable civil penalties in instances of ministerial or documentation errors not involving the nondelivery of services; use of a stratified or other scientifically valid method of statistical random sampling of equal or greater validity for auditing claims where an extrapolation methodology may be required for the computation of overpayments due to the high volume of claims involved; in instances where the provider is responsible for the state share of any reimbursement, a procedure limiting the recovery to the federal share of the reimbursement; in instances where the provider is not responsible for any portion of the reimbursement, a procedure for recovery of the entire reimbursement, including both the state and federal portion of such reimbursement; and procedures for the consideration and implementation of reasonable written comments and concerns submitted by providers.

2.  In the development and implementation of this plan, DMAS shall solicit and consider comments and suggestions from Medicaid providers.   DMAS shall complete and submit this plan to the Chairmen of the
House Appropriations and Senate Finance Committees, along with a summary of the written comments and suggestions from Medicaid providers,  no later than September 15, 2001, and shall implement the plan on October 15, 2001."


Explanation
(This amendment directs the Department of Medical Assistance Services to review and revise its audit procedures for community mental health, mental retardation, and substance abuse services, in cooperation with providers of those services.)