OFFICE OF FISCAL ANALYSIS

Legislative Office Building, Room 5200

Hartford, CT 06106 (860) 240-0200

http://www.cga.ct.gov/ofa

sHB-6550

AN ACT CONCERNING MEDICAID PROVIDER AUDITS.


OFA Fiscal Note

State Impact:

Agency Affected

Fund-Effect

FY 16 $

FY 17 $

Social Services, Dept.

GF - See Below

See Below

See Below

Note: GF=General Fund

Municipal Impact: None

Explanation

The bill could result in 1) a revenue loss associated with limiting when the Department of Social Services (DSS) can use extrapolation in claims involving clerical errors, and 2) a revenue gain associated with removing restrictions on the use of extrapolation of audited claims that do not involve clerical errors.

It cannot be known in advance to what extent the changes in the bill may impact current auditing results. For purposes of context, DSS identified over $43 million in gross recoveries (a cost avoidance of about $21 million) due to audits for FY 15 as of March 2015. Depending upon the type of audit, recoupments are either returned to the department to offset expenditures or booked to the General Fund as revenue.

The Out Years

The annualized ongoing fiscal impact identified above would continue into the future subject to inflation.