Connecticut HB 5354: AN ACT CONCERNING MEDICAID PROVIDER AUDITS.

Bill Text

Substitute House Bill No. 5354 
 
Public Act No. 26-143 
 
 
AN ACT CONCERNING MEDICAID PROVIDER AUDITS. 
Be  it  enacted  by  the  Senate  and  House  of  Representatives  in  General 
Assembly convened: 
 
Section  1.  Subdivision  (4)  of  subsection  (d)  of section  17b-99  of  the 
general  statutes  is  repealed  and  the  following  is  substituted  in  lieu 
thereof (Effective October 1, 2026): 
(4) A finding  of  overpayment  or  underpayment  to  a  provider  in  a 
program operated or administered by the department pursuant to this 
chapter or chapter 319t, 319v, 319y or 319ff, except a provider for which 
rates are established pursuant to section 17b-340, shall not be based on 
extrapolation unless the total net amount of extrapolated overpayment 
calculated   from   a   statistically   valid   sampling   and   extrapolation 
methodology  exceeds [one] two and  three-quarters  per  cent  of  total 
claims paid to the provider for the audit period. Beginning with audit 
review  periods  commencing  January  1,  2027,  the  commissioner  shall 
make available up-to-date education materials and technical assistance 
documents  to  assist  providers  with  proper  Medicaid  billing  prior  to 
extrapolation. 
 
Governor's Action: 
Approved June 2, 2026