Source: https://budget.lis.virginia.gov/amendment/2005/1/HB1500/Introduced/CR/326/14c/
Timestamp: 2019-09-17 14:54:00
Document Index: 700630735

Matched Legal Cases: ['§ 32', '§ 32', '§ 2', '§ 2', '§ 2', '§ 32', '§ 32']

326#14c (DMAS) Collection of Provider Overpayments. HB1500 - Conference Report
Bill Order » Item 326 #14c
Collection of Provider Overpayments (language only)
Item 326 #14c
"VVV.1. Notwithstanding the provisions of § 32.1-325.1:1, Code of Virginia, upon identifying that an overpayment for medical assistance services has been made to a provider, the Director of the Department of Medical Assistance Services shall notify the provider of the amount of the overpayment. Such notification of overpayment shall be issued within the earlier of (i) four years after payment of the claim or other payment request, or (ii) four years after filing by the provider of the complete cost report as defined in the Department of Medical Assistance Services' regulations, or (iii) 15 months after filing by the provider of the final complete cost report as defined in the Department of Medical Assistance Services' regulations subsequent to sale of the facility or termination of the provider.
2. Notwithstanding the provisions of § 32.1-325.1, Code of Virginia, the Director shall issue an informal fact-finding conference decision concerning provider reimbursement in accordance with the State Plan for Medical Assistance, the provisions of § 2.2-4019, Code of Virginia, and applicable federal law. The informal fact-finding conference decision shall be issued within 180 days of the receipt of the appeal request. If the agency does not render a decision within 180 days of the receipt of the appeal request, the decision is deemed to be in favor of the provider. An appeal of the Director's informal fact-finding conference decision concerning provider reimbursement shall be heard in accordance with § 2.2-4020 of the Administrative Process Act (§ 2.2-4020 et seq.) and the State Plan for Medical Assistance provided for in § 32.1-325, Code of Virginia. Once a final determination agency case decision has been made, the Director shall undertake full recovery of such overpayment whether or not the provider disputes, in whole or in part, the informal fact-finding conference decision or the final determination of agency case decision. Interest charges on the unpaid balance of any overpayment shall accrue pursuant to § 32.1-313, Code of Virginia, from the date the Director's agency case decision determination becomes final."
(This amendment adds language to eliminate conflicting uses of the term "initial determination" in the collection of Medicaid provider overpayments and the process for reviewing appeals involving provider reimbursement. The language also revises the timelines for notification to providers of Medicaid overpayments so that the notice would be issued within the earlier of: (i) four years after payment of the claim or other payment request; or (ii) four years after filing by the provider of the complete cost report; or (iii) 15 months after filing by the provider of the final complete cost report subsequent to the sale of the facility or termination of the provider.)