Budget Amendment ID: FY2012-S3-572

EHS 572

Medicaid Processing Accuracy

Mr. Kennedy moved that the proposed new text be amended Mr. Kennedy moved that the bill be amended by inserting, after Section ___, the following new Section:-

"SECTION __. Payments made by the Executive Office of Health and Human Services to providers for services payable under Title XIX of the Social Security Act shall be processed in a manner that maximizes federal financial participation.  Notwithstanding any general or special law to the contrary, the Executive Office of Health and Human Services shall process all such payments to MassHealth providers and recoupments from MassHealth providers in accordance with the policies and procedures established under a Medicaid Management Information System (“MMIS”) that has received express Federal approval under Title XIX of the Social Security Act.

(a) Any determination (including any determination for which an appeal is pending pursuant to 130 CMR 450.241 et seq.) that an overpayment has been made to a non-acute hospital, as defined in Massachusetts General Laws Chapter 118G, Section 1, with respect to services to patients who are eligible for benefits under both Titles XVIII and XIX of the Social Security Act and for which funds have not been recouped from the non-acute hospital, shall not be recovered, recouped or deemed final unless: (1) the determination of the overpayment was made in accordance with the policies and procedures of a Federally-approved MMIS; (2) the Executive Office of Health and Human Services has provided the non-acute hospital with documentation, which shall include patient-specific remittance advices which are sufficient in form and substance for approval by Medicare auditors of the overpayment amount as an allowable bad debt under Title XVIII of the Social Security Act; and, (3) the non-acute hospital has received interim payments under Title XVIII of the Social Security Act based upon the non-acute hospital’s claim of bad debt reimbursement relating to the overpayment.

(b) Any determination (including any determination for which an appeal is pending pursuant to 130 CMR 450.241 et seq.) than an overpayment has been made to a hospital, as defined in Massachusetts General Law Chapter 118G, Section 1, with respect to services to patients who are eligible for benefits under both Titles XVIII and XIX of the Social Security Act and for which funds already have been recouped without first being processed through a Federally-approved MMIS: (1) shall result in a reversal of the prior determination  and, (2) shall not be deemed final unless: (A) a new determination of overpayment is made in accordance with the policies and procedures of a Federally-approved MMIS; (B) the Executive Office of Health and Human Services has provided the hospital with documentation, which shall include patient-specific remittance advices which are sufficient in form and substance for approval by Medicare auditors of the newly-determined overpayment amount as an allowable bad debt under Title XVIII of the Social Security Act; and, (C) the  hospital has received interim payments under Title XVIII of the Social Security Act based upon the hospital’s claim of bad debt reimbursement relating to the newly-determined overpayment."