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General Assembly Raised Bill No. 836
January Session, 2019
LCO No. 4010
Referred to Committee on HUMAN SERVICES
Introduced by:
(HS)
AN ACT HOLDING HARML ESS MEDICAID CLIENTS AND PROVIDER S
AFFECTED BY AGENCY C OMPUTER ERRORS.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. Subdivision (5) of subsection (d) of section 17b-99 of the 1
general statutes is repealed and the following is substituted in lieu 2
thereof (Effective July 1, 2019): 3
(5) In conducting any audit pursuant to this subsection, the 4
commissioner, or any entity with which the commissioner contracts to 5
conduct such audit, shall accept (A) as sufficient proof of a written 6
order: A photocopy, facsimile image, an electronically maintained 7
document or original pen and ink document, and (B) as sufficient 8
proof of delivery of a covered item or service: A receipt signed by the 9
recipient of medical assistance or a nursing facility representative or, in 10
the case of delivery of a covered item or service by a shipping or 11
delivery service, a supplier's detailed shipping invoice and the 12
delivery service tracking information substantiating delivery. The 13
commissioner, or any entity with which the commissioner contracts to 14
conduct such audit, may s eek additional documentation in 15 Raised Bill No. 836
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circumstances including, but not limited to: (i) The proof provided is 16
insufficiently legible, (ii) the proof provided is contradicted by other 17
sources of information reviewed in the audit, or (iii) the commissioner, 18
or any entity with which the commissioner contracts to conduct such 19
audit, makes a good faith determination that the provider may be 20
engaging in vendor fraud. A provider, in complying with the 21
requirements of any such audit, shall be allowed not less than thirty 22
days to provide documentation in connection with any discrepancy 23
discovered and brought to the attention of such provider in the course 24
of any such audit. Such documentation may include evidence that 25
errors concerning payment and billing resulted from (I) a provider's 26
transition to a new payment or billing service or accounting system, or 27
(II) the implementation of any new computer system by the 28
Department of Social Services. The commissioner shall not calculate an 29
overpayment based on extrapolation or attempt to recover such 30
extrapolated overpayment when the provider presents credible 31
evidence that an error by the commissioner, or any entity with which 32
the commissioner contracts to conduct an audit pursuant to this 33
subsection, caused the overpayment, provided the commissioner may 34
recover the amount of the original overpayment. 35
Sec. 2. Subsection (a) of section 17b-80 of the general statutes is 36
repealed and the following is substituted in lieu thereof (Effective July 37
1, 2019): 38
(a) The commissioner, upon receipt of an application for aid, shall 39
promptly and with due diligence make an investigation, such 40
investigation to be completed within forty-five days after receipt of the 41
application or within sixty days after receipt of the application in the 42
case of an application in which a determination of disability must be 43
made. If an application for an award is not acted on within forty-five 44
days after the filing of an application, or within sixty days in the case 45
of an application in which a determination of disability must be made, 46
the applicant may apply to the commissioner for a hearing in 47
accordance with sections 17b-60 and 17b-61. The commissioner shall 48
grant aid only if he finds the applicant eligible therefor, in which case 49 Raised Bill No. 836
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he shall grant aid in such amount, determined in accordance with 50
levels of payments established by the commissioner, as is needed in 51
order to enable the applicant to support himself, or, in the case of 52
temporary family assistance, to enable the relative to support such 53
dependent child or children and himself, in health and decency, 54
including the costs of such medical care as he deems necessary and 55
reasonable, not in excess of the amounts set forth in the various fee 56
schedules promulgated by the Commissioner of Social Services for 57
medical, dental and allied services and supplies or the charges made 58
for comparable services and supplies to the general public, whichever 59
is less, and the cost of necessary hospitalization as is provided in 60
section 17b-239, over and above hospital insurance or other such 61
benefits, including workers' compensation and claims for negligent or 62
wilful injury. The commissioner, subject to the provisions of subsection 63
(b) of this section, shall in determining need, take into consideration 64
any available income and resources of the individual claiming 65
assistance. The commissioner shall make periodic investigations to 66
determine eligibility and may, at any time, modify, suspend or 67
discontinue an award previously made when such action is necessary 68
to carry out the provisions of the state supplement program, medical 69
assistance program, temporary family assistance program, state-70
administered general assistance program or supplemental nutrition 71
assistance program. Notwithstanding the provisions of this subsection, 72
the commissioner shall not fail to grant assistance nor modify, suspend 73
or discontinue an award previously made when there is credible 74
evidence that the implementation of a new computer system at the 75
Department of Social Services caused delays or errors that prevented 76
an individual from providing timely, accurate information necessary 77
to determine eligibility for assistance. The parent or parents of any 78
child for whom aid is received under the temporary family assistance 79
program and any beneficiary receiving assistance under the state 80
supplement program shall be conclusively presumed to have accepted 81
the provisions of sections 17b-93, 17b-94 and 17b-95. 82 Raised Bill No. 836
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This act shall take effect as follows and shall amend the following
sections:
Section 1 July 1, 2019 17b-99(d)(5)
Sec. 2 July 1, 2019 17b-80(a)
Statement of Purpose:
To prohibit penalties against Medicaid providers or clients due to
delays or errors caused by the conversion by the Department of Social
Services to a new computer system.
[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline,
except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is
not underlined.]