,,ii  #aai? ,,congress  #b;d ,session   
,s4 #dhih  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,june #bd1 #bjbf,mr4   
,scott ( ,florida introduc$ ! foll[+    
bill2 :i* 0 read twice & ref]r$ to !    
,committee on ,f9ance  ,a ,,bill  ,to   
implem5t recomm5dations ( ! ,comptroll] 
,g5]al ( ! ,unit$ ,/ates = improv+ !    
,m$icaid ,recov]y ,audit ,contractor    
program & id5tify+ additional           
opportunities to recov] ,m$icaid        
ov]paym5ts1 & = o!r purposes4  #a4 ,%ort
 title ,?is ,act may be cit$ z !        
,m$icaid ,,rac ,improvem5t ,act ( #bjbf4
  #b4 ,improv+ ,,cms ov]sight &         
communication  7a7 ,improv$ ov]sight    
,section #aijc ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #acif;b7 is am5d$ by
 add+ at ! end ! foll[+ new subsection3 
7cc7 ,improv+ ,/ate paym5t integrity    
7#a7 ,def9itions ,9 ?is subsection3 7,a7
 ,m$icaid ,,rac program ,! t]m ,m$icaid 
,,rac program means a program describ$ 9
 section #aijb7;a77#db77;,b77i74  7,b7  
,,rac exception ,,spa ,! t]m ,,rac      

exception ,,spa means a ,/ate plan      
am5dm5t submitt$ to ! ,secret>y by a    
,/ate = approval ( a full exception f1  
or an exception to #a or m (1 !         
requirem5ts describ$ 9 section          
#aijb7;a77#db77;,b74  7#b7 ,improv$     
ov]sight ( ,m$icaid ,,rac program       
exceptions ,n lat] ?an #ahj days aft] ! 
date ( enactm5t ( ?is subsection1 !     
,secret>y %all e/abli% & implem5t       
policies & proc$ures = ! foll[+3 7,a7   
,communicate expiration ( ,m$icaid ,,rac
 program exception ,cle>ly communicat+  
to a ,/ate ) an approv$ ,,rac exception 
,,spa-- 7i7 ! expiration date ( !       
approval2 &  7ii7 a /atem5t t ! ,,rac   
exception ,,spa approval expiration date
 %all n be ext5d$ aft] #bjbi4  7,b7     
,monitor+ ( ,,rac exception ,,spa       
expirations ,monitor+ ( ,,rac exception 
,,spa expiration dates & notify+ ,/ates 
) respect to any upcom+ expiration date4
  7,c7 ,/ate reports ,requir+ annual1   
detail$ report+ f a ,/ate ) an approv$  
,,rac exception ,,spa t includes an     

ov]view ( ! ,/ate's ,m$icaid ,,rac      
program1 includ+ me?odologies &         
ju/ifications = audit limits or         
exclusions appli$ "u ! program4  7#c7   
,improv$ report+ to ,congress on !      
effectiv5ess ( ! ,m$icaid ,,rac program 
7,a7 ,9 g5]al ,n lat] ?an ,decemb] #ca1 
#bjbg1 & annually !reaft]1 ! ,secret>y1 
9 collaboration ) ,/ate ,m$icaid        
ag5cies1 %all submit to ,congress a     
report describ+ ! effectiv5ess ( !      
,m$icaid ,,rac program = ! mo/ rec5tly  
end$ fiscal ye>4  7,b7 ,cont5ts ,ea*    
report submitt$ by ! ,secret>y to       
,congress "u subp>agraph 7,a7 %all      
include ! foll[+ in=mation ) respect to 
! report+ p]iod3 7i7 ,/ate-specific     
in=mation ,= ea* ,/ate3 7,i7 ,a summ>y (
 ! ,/ate's ,m$icaid ,,rac program1      
includ+ me?odologies & ju/ifications =  
audit limits or exclusions appli$ "u !  
program1 & a description ( any approv$  
exceptions4  7,,ii7 ,! aggregate am\nt (
 ,m$icaid ov]paym5ts recov]$ & ! am\nt (
 ea* ov]paym5t recov]$4  7,,iii7 ,!     

aggregate am\nt ( ,m$icaid und]paym5ts &
 ! am\nt 7actual or e/imat$7 ( ea*      
und]paym5t4  7,,iv7 ,if ! ,/ate t has   
implem5t$ pre-paym5t review ( ,m$icaid  
paym5ts to b5efici>ies1 ! aggregate     
am\nt ( sav+s 7actual or e/imat$7       
attributable to su* pre-paym5t review4  
7,v7 ,! p]c5tage ( appeals ( dem&s =    
ov]paym5t t end$ 9 settlem5t &1 )       
respect to any su* settlem5t am\nt1 !   
p]c5tage ( su* am\nt 9 comp>ison to !   
orig9al ov]paym5t dem&$4  7,,vi7 ,! #e  
initiatives mo/ (t5 implem5t$ by ! ,/ate
 to r$uce ov]paym5ts & und]paym5ts4     
7,,vii7 ,! numb] ( audit categories--   
7aa7 conduct$ by a ,/ate2 or  7bb7 on   
hold or d5i$ by a ,/ate4  7ii7 ,secret>y
 recomm5dations ,recomm5dations = exp&+ 
or improv+ ! ,m$icaid ,,rac program1 z !
 ,secret>y det]m9es appropriate4  4  7b7
 ,con=m+ am5dm5t ,section               
#aijb7;a77#db77;,b77i7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#acif;a7a77#db77;,b77i77 is am5d$ by    
ins]t+ 7b only ?r\gh ,decemb] #ca1      

#bjbh7 aft] exceptions4  #c4 ,requir+   
,m$icaid manag$ c>e plans to be includ$ 
9 ,m$icaid ,,rac programs ,section      
#aijb7;a77#db7 ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #acif;a7a77#db77 is 
am5d$-- 7#a7 9 subp>agraph 7,a71 by     
/rik+ & at ! end2  7#b7 9 subp>agraph   
7,b77ii7-- 7,a7 9 subclause 7,,iii71 by 
/rik+ & at ! end2 &  7,b7 by add+ at !  
end ! foll[+ new subclause3  7,v7 su*   
program is c>ri$ out 9 a robu/ mann]    
likely to id5tify & rec\p or prev5t a   
sub/antial portion ( ov]paym5ts &       
specifically includes a review ( claims 
paid by m$icaid manag$ c>e organizations
 7z def9$ 9 section #aijc7m77#a77;,a771 
prepaid inpati5t heal? plans 7z def9$ 9 
section #aijc7m77#i77;,d77iii77,i771 &  
prepaid ambulatory heal? plans 7z def9$ 
9 section #aijc7m77#i77;,d77iii77,,ii772
  2 &  7#c7 by add+ at ! end ! foll[+   
new subp>agraph3  7,c7 n lat] ?an       
,janu>y #a1 #bjbh1 ! ,/ate %all provide 
assurances satisfactory to ! ,secret>y t
 ! ,/ate has an adequate process =      

ensur+ t any contract ) a m$icaid manag$
 c>e organization 7z def9$ 9 section    
#aijc7m77#a77;,a771 prepaid inpati5t    
heal? plan 7z def9$ 9 section           
#aijc7m77#i77;,d77iii77,i771 or prepaid 
ambulatory heal? plan 7z def9$ 9 section
 #aijc7m77#i77;,d77iii77,,ii771 & a     
,/ate %all include provisions "u :i* su*
 an organization or heal? plan--  7i7   
%all ei!r--  7,i7 elect to engage 9 a   
p]iod ( paym5t integrity review by      
designat+ a p]iod 7n to exce$ ! less] ( 
#ah mon?s aft] paym5t = a claim or ! t]m
 ( ! contract ) ! manag$ c>e            
organization7 dur+ :i* ! organization or
 heal? plan %all be p]mitt$ to engage 9 
ef=ts to id5tify und]paym5ts &          
ov]paym5ts & rec\p ov]paym5ts "u ! ,/ate
 plan & "u any waiv] ( ! ,/ate plan )   
respect to all s]vices = :i* paym5t is  
made to ! organization or heal? plan "u 
su* plan or waiv]2 or  7,,ii7 agree to  
p]mit a ,m$icaid recov]y audit          
contractor 7z describ$ 9 subp>agraph    
7,b77 engag$ by ! ,/ate to engage 9 su* 

paym5t integrity review2 &  7ii7 %all   
agree to-- 7,i7 coop]ate ) any ,m$icaid 
recov]y audit contractor 7z s describ$7 
engag$ by ! ,/ate to id5tify any su*    
und]paym5ts & ov]paym5ts & rec\p any    
ov]paym5ts "u ! ,/ate plan & "u any     
waiv] ( ! ,/ate plan 7aft] ! expiration 
( ! p]iod designat$ "u clause 7i77,i71  
if ! organization or heal? plan has     
elect$ su* a p]iod72 &  7,,ii7 coord9ate
 su* recov]y audit ef=ts 9 ! same mann] 
describ$ 9 subp>agraph                  
7,b77ii77,,iv77cc72 &  4  #d4           
,additional measures = improv+ ,m$icaid 
paym5t integrity  7a7 ,annual reports   
reg>d+ ,/ate paym5t integrity reviews   
,section #aijc7;cc7 ( ! ,social         
,security ,act 7#db ,u4,s4,c4 #acif;b71 
z add$ by section #b7;a7 ( ?is ,act1 is 
am5d$ by add+ at ! end ! foll[+ new     
p>agraph3  7#d7 ,annual reports reg>d+  
,/ate paym5t integrity reviews  7,a7    
,/ate reports ,n lat] ?an #a ye> aft] ! 
date ( enactm5t ( ?is p>agraph1 &       
annually !reaft]1 ea* ,/ate %all submit1

 sep>ate f ! in=mation report$ "u       
p>agraph 7#b77;,c71 a report to !       
,secret>y1 9 su* /&>d =m & mann] z !    
,secret>y %all specify1 t id5tifies !   
review+ entity 7includ+ any recov]y     
audit contractor or o!r program         
integrity entity7 = ea* paym5t /ream    
7includ+ a non-,/ate fund$ paym5t &     
capitation or o!r paym5ts made to a     
m$icaid manag$ c>e organization 7z def9$
 9 section #aijc7m77#a77;,a771 prepaid  
inpati5t heal? plan 7z def9$ 9 section  
#aijc7m77#i77;,d77iii77,i771 or prepaid 
ambulatory heal? plan 7z def9$ 9 section
 #aijc7m77#i77;,d77iii77,,ii777 "u !    
,/ate plan or "u a waiv] ( su* ,/ate    
plan ) respect to all items & s]vices = 
:i* paym5t is made = ! applicable       
report+ p]iod4  7,b7 ,reports to        
,congress ,n lat] ?an #ahj days aft] !  
date ( ea* annual ,/ate report+ deadl9e 
"u subp>agraph 7,a71 ! ,secret>y %all   
prep>e & submit to ,congress a report   
detail+ ! in=mation conta9$ 9 su* ,/ate 
reports1 toge!r ) recomm5dations = su*  

legislation & adm9i/rative action z !   
,secret>y det]m9es appropriate4  4  7b7 
,id5tify+ & te/+ b>ri]s to ,/ate        
p>ticipation 9 ,m$icaid ,,rac programs  
,section #aijc7;cc7 ( ! ,social         
,security ,act1 z am5d$ by subsection   
7a71 is am5d$ by add+ at ! end ! foll[+ 
new p>agraphs3  7#e7 ,/udy on b>ri]s to 
,/ate p>ticipation 9 ,m$icaid ,,rac     
programs  7,a7 ,9 g5]al ,! ,secret>y    
%all conduct a /udy on b>ri]s to ,/ate  
e/abli%m5t & implem5tation ( ,m$icaid   
,,rac programs z requir$ "u section     
#aijb7;a77#db77;,b77i74 ,su* /udy %all  
exam9e-- 7i7 ! cont+5cy fee paym5t      
/ructure = recov]y audit contractors1   
includ+-- 7,i7 :e!r su* paym5t /ructure 
ensures a heal?y & competitive          
m>ketplace = ,/ates to e/abli% &        
implem5t ,m$icaid ,,rac programs2 &     
7,,ii7 ! effectiv5ess ( su* paym5t      
/ructure bas$ on ! population ( a ,/ate 
t p>ticipates 9 ! ,/ate ,m$icaid        
program2  7ii7 alt]native arrangem5ts = 
engag+ recov]y audit contractors1       

includ+ ! viability ( multi-,/ate       
contracts2 &  7iii7 ! />t up co/s       
associat$ ) e/abli%+ a new ,m$icaid     
,,rac program 9 a ,/ate1 includ+-- 7,i7 
! am\nt ( "t be=e a recov]y audit       
contractor />ts rec\p+ ov]paym5ts to !  
ext5t t ! recov]y audit contractor      
recov]s su* />t up co/s2 &  7,,ii7      
recomm5dations = a paym5t /ructure t    
c\ld include initial fund+ to a recov]y 
audit contractor4  7,b7 ,report ,n lat] 
?an #a ye> aft] ! date ( enactm5t ( ?is 
p>agraph1 ! ,secret>y %all submit to    
,congress a report conta9+ ! results ( !
 /udy conduct$ "u subp>agraph 7,a71     
toge!r ) recomm5dations = su*           
legislation & adm9i/rative action z !   
,secret>y det]m9es appropriate4  7#f7   
,demon/ration project to improve ,/ate  
p>ticipation 9 ,m$icaid ,,rac programs  
7,a7 ,9 g5]al ,n lat] ?an #b ye>s aft] !
 date ( enactm5t ( ?is p>agraph1 bas$ on
 ! /udy conduct$ "u p>agraph 7#e71 !    
,secret>y %all conduct a #e-ye>         
demon/ration project design$ to increase

 ! numb] ( ,/ates t e/abli% & implem5t a
 ,m$icaid ,,rac program 9 accordance )  
section #aijb7;a77#db77;,b77i74  7,b7   
,reports to ,congress ,! ,secret>y %all 
submit an int]im report to ,congress on 
! demon/ration project conduct$ "u ?is  
p>agraph n lat] ?an #ij days aft] !     
initiation ( ! demon/ration project1 & a
 f9al report n lat] ?an #ahj days aft] !
 demon/ration project ends4 ,! f9al     
report %all include an evaluation ( !   
project & recomm5dations = su*          
legislation & adm9i/rative action z !   
,secret>y det]m9es appropriate4  4  7c7 
,audit & recov]y p]iods ,section        
#aijb7;a77#db7 ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #acif;a7a77#db771 z 
am5d$ by section #c1 is am5d$ by add+ at
 ! end ! foll[+ new subp>agraph3  7,d7  
not)/&+ clause 7i7 ( subp>agraph 7,b71  
beg9n+ #abj days aft] ! date ( enactm5t 
( ?is subp>agraph1 ea* contract ent]$   
into by ! ,/ate ) a recov]y audit       
contractor "u ! program describ$ 9      
subp>agraph 7,b71 includ+ any contract )

 a recov]y audit contractor apply+ to a 
m$icaid manag$ c>e organization 7z def9$
 9 section #aijc7m77#a77;,a771 prepaid  
inpati5t heal? plan 7z def9$ 9 section  
#aijc7m77#i77;,d77iii77,i771 or prepaid 
ambulatory heal? plan 7z def9$ 9 section
 #aijc7m77#i77;,d77iii77,,ii771 %all    
provide t audit & recov]y activities    
%all be conduct$ dur+ a fiscal ye> )    
respect to paym5ts made "u ! ,/ate plan 
& "u any waiv] ( ! ,/ate plan1 or1 if   
applicable1 paym5ts made by su* an      
organization or heal? plan1 dur+ su*    
fiscal ye> & retrospectively = a p]iod (
 #d fiscal ye>s prior to su* fiscal ye>2
  4