HB 26-1412

HB 26-1412, a Colorado bill that has been signed into law, allows the Department of Health Care Policy and Financing to use statistical methods to identify and recover overpayments made to Medicaid providers who offer nonemergency medical transportation or pediatric behavioral therapy services. This applies specifically to audits initiated after July 1, 2026, for services provided between January 1, 2022, and December 31, 2025. The law also mandates that the state auditor reviews these audit methods annually and reports findings to relevant committees. This bill affects Medicaid providers who offer specific nonemergency medical transportation or pediatric behavioral therapy services in Colorado. Since it has been signed into law, the provisions will take effect as scheduled, impacting how audits are conducted and overpayments are recovered from these service providers starting in 2026.

Official Summary

If an audit of a medicaid provider who provides nonemergency medical transportation services or pediatric behavioral therapy is initiated after July 1, 2026, for services provided from January 1, 2022, through December 31, 2023, the act authorizes the department of health care policy and financing (HCPF) to determine and recover overpayments to a provider using statistical sampling and extrapolation. If an audit identifies a statistically significant pattern of alleged overpayments to a provider, the act authorizes the state auditor to use the same statistical sampling and extrapolation methods to audit services provided by the provider from January 1, 2024, through December 31, 2025.     If the audit identifies an alleged overpayment, HCPF is required to issue a notice of the alleged overpayment within 60 days after the alleged overpayment is identified. The notice of alleged overpayment must include the basis of the alleged overpayment, the rationale for the alleged overpayment, the methodology used to calculate the alleged overpayment, and information on how HCPF identified the alleged overpayment.     If HCPF enters into a contract for the purpose of conducting an audit, the contract must not be a contingency-based contract based on a percentage of the amount of recovery collected from the provider.     After HCPF completes an audit of a provider, the state auditor's office is required to conduct an examination to determine that proper statistical sampling and extrapolation methods were used by HCPF when determining whether overpayments were made to a provider. The state auditor shall annually present a report of the findings to the legislative audit committee and the joint budget committee.     The act reduces the general fund appropriation to HCPF for medical and long-term care services for Medicaid-eligible individuals by $6,861,775 and increases the cash fund appropriation to HCPF for medical and long-term care services for Medicaid-eligible individuals by $13,723,550.(Note: This summary applies to this bill as enacted.)

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