Connecticut 2019 Regular Session

Connecticut Senate Bill SB00836 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1
2	2
3	3	LCO No. 4010 1 of 4
4	4
5	5	General Assembly Raised Bill No. 836
6	6	January Session, 2019
7	7	LCO No. 4010
8	8
9	9
10	10	Referred to Committee on HUMAN SERVICES
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12	12
13	13	Introduced by:
14	14	(HS)
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19	19	AN ACT HOLDING HARML ESS MEDICAID CLIENTS AND PROVIDER S
20	20	AFFECTED BY AGENCY C OMPUTER ERRORS.
21	21	Be it enacted by the Senate and House of Representatives in General
22	22	Assembly convened:
23	23
24	24	Section 1. Subdivision (5) of subsection (d) of section 17b-99 of the 1
25	25	general statutes is repealed and the following is substituted in lieu 2
26	26	thereof (Effective July 1, 2019): 3
27	27	(5) In conducting any audit pursuant to this subsection, the 4
28	28	commissioner, or any entity with which the commissioner contracts to 5
29	29	conduct such audit, shall accept (A) as sufficient proof of a written 6
30	30	order: A photocopy, facsimile image, an electronically maintained 7
31	31	document or original pen and ink document, and (B) as sufficient 8
32	32	proof of delivery of a covered item or service: A receipt signed by the 9
33	33	recipient of medical assistance or a nursing facility representative or, in 10
34	34	the case of delivery of a covered item or service by a shipping or 11
35	35	delivery service, a supplier's detailed shipping invoice and the 12
36	36	delivery service tracking information substantiating delivery. The 13
37	37	commissioner, or any entity with which the commissioner contracts to 14
38	38	conduct such audit, may s eek additional documentation in 15 Raised Bill No. 836
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40	40
41	41
42	42	LCO No. 4010 2 of 4
43	43
44	44	circumstances including, but not limited to: (i) The proof provided is 16
45	45	insufficiently legible, (ii) the proof provided is contradicted by other 17
46	46	sources of information reviewed in the audit, or (iii) the commissioner, 18
47	47	or any entity with which the commissioner contracts to conduct such 19
48	48	audit, makes a good faith determination that the provider may be 20
49	49	engaging in vendor fraud. A provider, in complying with the 21
50	50	requirements of any such audit, shall be allowed not less than thirty 22
51	51	days to provide documentation in connection with any discrepancy 23
52	52	discovered and brought to the attention of such provider in the course 24
53	53	of any such audit. Such documentation may include evidence that 25
54	54	errors concerning payment and billing resulted from (I) a provider's 26
55	55	transition to a new payment or billing service or accounting system, or 27
56	56	(II) the implementation of any new computer system by the 28
57	57	Department of Social Services. The commissioner shall not calculate an 29
58	58	overpayment based on extrapolation or attempt to recover such 30
59	59	extrapolated overpayment when the provider presents credible 31
60	60	evidence that an error by the commissioner, or any entity with which 32
61	61	the commissioner contracts to conduct an audit pursuant to this 33
62	62	subsection, caused the overpayment, provided the commissioner may 34
63	63	recover the amount of the original overpayment. 35
64	64	Sec. 2. Subsection (a) of section 17b-80 of the general statutes is 36
65	65	repealed and the following is substituted in lieu thereof (Effective July 37
66	66	1, 2019): 38
67	67	(a) The commissioner, upon receipt of an application for aid, shall 39
68	68	promptly and with due diligence make an investigation, such 40
69	69	investigation to be completed within forty-five days after receipt of the 41
70	70	application or within sixty days after receipt of the application in the 42
71	71	case of an application in which a determination of disability must be 43
72	72	made. If an application for an award is not acted on within forty-five 44
73	73	days after the filing of an application, or within sixty days in the case 45
74	74	of an application in which a determination of disability must be made, 46
75	75	the applicant may apply to the commissioner for a hearing in 47
76	76	accordance with sections 17b-60 and 17b-61. The commissioner shall 48
77	77	grant aid only if he finds the applicant eligible therefor, in which case 49 Raised Bill No. 836
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79	79
80	80
81	81	LCO No. 4010 3 of 4
82	82
83	83	he shall grant aid in such amount, determined in accordance with 50
84	84	levels of payments established by the commissioner, as is needed in 51
85	85	order to enable the applicant to support himself, or, in the case of 52
86	86	temporary family assistance, to enable the relative to support such 53
87	87	dependent child or children and himself, in health and decency, 54
88	88	including the costs of such medical care as he deems necessary and 55
89	89	reasonable, not in excess of the amounts set forth in the various fee 56
90	90	schedules promulgated by the Commissioner of Social Services for 57
91	91	medical, dental and allied services and supplies or the charges made 58
92	92	for comparable services and supplies to the general public, whichever 59
93	93	is less, and the cost of necessary hospitalization as is provided in 60
94	94	section 17b-239, over and above hospital insurance or other such 61
95	95	benefits, including workers' compensation and claims for negligent or 62
96	96	wilful injury. The commissioner, subject to the provisions of subsection 63
97	97	(b) of this section, shall in determining need, take into consideration 64
98	98	any available income and resources of the individual claiming 65
99	99	assistance. The commissioner shall make periodic investigations to 66
100	100	determine eligibility and may, at any time, modify, suspend or 67
101	101	discontinue an award previously made when such action is necessary 68
102	102	to carry out the provisions of the state supplement program, medical 69
103	103	assistance program, temporary family assistance program, state-70
104	104	administered general assistance program or supplemental nutrition 71
105	105	assistance program. Notwithstanding the provisions of this subsection, 72
106	106	the commissioner shall not fail to grant assistance nor modify, suspend 73
107	107	or discontinue an award previously made when there is credible 74
108	108	evidence that the implementation of a new computer system at the 75
109	109	Department of Social Services caused delays or errors that prevented 76
110	110	an individual from providing timely, accurate information necessary 77
111	111	to determine eligibility for assistance. The parent or parents of any 78
112	112	child for whom aid is received under the temporary family assistance 79
113	113	program and any beneficiary receiving assistance under the state 80
114	114	supplement program shall be conclusively presumed to have accepted 81
115	115	the provisions of sections 17b-93, 17b-94 and 17b-95. 82 Raised Bill No. 836
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118	118
119	119	LCO No. 4010 4 of 4
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121	121	This act shall take effect as follows and shall amend the following
122	122	sections:
123	123
124	124	Section 1 July 1, 2019 17b-99(d)(5)
125	125	Sec. 2 July 1, 2019 17b-80(a)
126	126
127	127	Statement of Purpose:
128	128	To prohibit penalties against Medicaid providers or clients due to
129	129	delays or errors caused by the conversion by the Department of Social
130	130	Services to a new computer system.
131	131	[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline,
132	132	except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is
133	133	not underlined.]
134	134