NOTICE OF PROPOSED CHANGES ON MEDICAID AUDIT AND REVIEW IN THE REGULATIONS OF THE DEPARTMENT OF HEALTH & SOCIAL SERVICES.
BRIEF DESCRIPTION The Department of Health & Social Services proposes to change regulations on Medicaid audit and review of medical assistance providers, self-review conducted by providers, interest applied to overpayments, and provider records. |
The Department of Health & Social Services proposes to adopt regulation changes in Title 7 of the Alaska Administrative Code, dealing with audit and review of Medicaid providers, self-review, and overpayments, including the following:
- 7 AAC 105.230. Requirements for provider records – is proposed to be amended to revise the record keeping requirements for medical assistance providers, including electronic record requirements, unit of service, and timesheets.
- 7 AAC 120.430. Authorized escort – is proposed to be amended to revise the claim requirements for hotels.
- 7 AAC 160.110. Fiscal audit - is proposed to be amended to revise the fiscal audit procedures, including subcontractors and grantees, record keeping, access to records, sanctions, and interest paid on overpayments.
- 7 AAC 160.115. Duty of a provider to identify and repay self-identified overpayments - is a proposed new section that requires providers to conduct a self-review of a random sample of claims and return any overpayments to the department.
- 7 AAC 160.120. Use of statistical sampling - is proposed to be amended to include providers to use statistically valid sampling methodologies when conducting self-reviews.
- 7 AAC 160.130. Appeal - is proposed to be amended to revise the appeal procedures and options, including reconsideration by the department.
- 7 AAC 160.140. Quality assurance program - is proposed to be amended to revise the quality assurance program requirements.
You may comment on the proposed regulation changes, including the potential costs to private persons of complying with the proposed changes, by submitting written comments to Mr. Doug Jones at douglas.jones@alaska.gov or at 4601 Business Park Blvd., Building K, Anchorage, AK 99503. The comments must be received not later than 5 p.m. on September 22, 2017.
Oral or written comments also may be submitted at a hearing to be held on September 1, 2017, at the Frontier Building, in Conference Rooms Number 880, 890, and 896, 3601 C St., Anchorage, AK 99503. The hearing will be held from 9:00 a.m. – 12:00 p.m. and might be extended to accommodate those present before 11 a.m. who did not have an opportunity to comment. If you are unable to attend in person, but would like to comment during the oral public hearing, you can call the teleconference number (800) 945-9434 (Toll Free).
You may submit written questions relevant to the proposed action to Mr. Doug Jones at douglas.jones@alaska.gov or at 4601 Business Park Blvd., Building K, Anchorage, AK 99503. The questions must be received at least 10 days before the end of the public comment period. The Department of Health & Social Services will aggregate its response to substantially similar questions and make the questions and response available on the Alaska Online Public Notice System at https://aws.state.ak.us/OnlinePublicNotices/ and on the department website at http://dhss.alaska.gov/Commissioner/Pages/ProgramIntegrity/default.aspx.
If you are a person with a disability who needs a special accommodation in order to participate in this process, please contact Mr. Doug Jones at douglas.jones@alaska.gov or at (907) 269-0361 not later than August 21, 2017, to ensure that any necessary accommodations can be provided.
A copy of the proposed regulation changes is available on the Alaska Online Public Notice System and by contacting Mr. Doug Jones at douglas.jones@alaska.gov or at (907) 269-0361.
After the public comment period ends, the Department of Health & Social Services will either adopt the proposed regulation changes or other provisions dealing with the same subject, without further notice, or decide to take no action. The language of the final regulation may be different from that of the proposed regulation. You should comment during the time allowed if your interests could be affected.
Statutory authority: AS 47.05.010; AS 47.05.200; AS 47.05.235; AS 47.07.030; AS 47.07.040; AS 47.07.074.
Statutes being implemented, interpreted, or made specific: AS 47.05.010; AS 47.05.200; AS 47.07.030; AS 47.07.040; AS 47.07.074.
Fiscal information: The proposed regulation changes are not expected to require an increased appropriation.
DATE: July 24, 2017.
/s/Jon Sherwood
Deputy Commissioner
Department of Health & Social Services