SB 25-314: Recovery Audit Contractor Program

Official summary

Abstract published by the legislature (via Open States). Text as published by the legislature; reproduced verbatim.

The act allows the department of health care policy and financing (department) to, on behalf of the department, contract with a recovery audit contractor (RAC) vendor to conduct RAC audits of medicaid providers (providers). RAC audits may only review claims that are no more than 3 years past the expiration date of the timely filing period. The department may only review claims that fall outside of this 3-year time frame if required by a federal audit. The act limits the number of audits a provider may undergo each year and the number of medical records that can be requested for a given audit. If the RAC vendor identifies preliminary findings during the RAC audit, the RAC vendor must send the provider a report detailing the preliminary findings, the rationale for the preliminary findings, and the methodology for how any overpayments were calculated and determined. The act allows a provider that received preliminary findings following a complex audit to request an exit conference to discuss the preliminary findings with the RAC vendor and the department to resolve the concerns detailed in the preliminary findings prior to undergoing an informal reconsideration of the preliminary findings. A provider is required to participate in an informal reconsideration before filing a formal appeal regarding the department's findings during an RAC audit. The department is required to submit an annual report to the joint budget committee containing information about the RAC audits conducted and the department's involvement in those RAC audits. The act, in the department's budget for medical and long-term care services for medical-eligible individuals, decreases the cash funds appropriation from recoveries and recoupments by $20,900,588 and increases the cash funds appropriation from the recovery audit contractor recoveries cash fund by $20,900,588. (Note: This summary applies to this bill as enacted.)

Sponsors

Sponsors by party (alphabetical): Democratic 8 · Republican 4

“Support” is shown only as formal sponsorship recorded by the legislature. Roll-call votes are available on the official bill page.

Recent official actions

1. June 3, 2025Governor Signed
2. May 13, 2025Sent to the Governor
3. May 13, 2025Signed by the President of the Senate
4. May 13, 2025Signed by the Speaker of the House
5. May 2, 2025House Third Reading Passed - No Amendments
6. May 1, 2025House Committee on Appropriations Refer Unamended to House Committee of the Whole
7. May 1, 2025House Second Reading Special Order - Passed - No Amendments
8. April 30, 2025Senate Third Reading Passed - No Amendments
9. April 30, 2025Introduced In House - Assigned to Appropriations
10. April 29, 2025Senate Committee on Appropriations Refer Amended to Senate Committee of the Whole
11. April 29, 2025Senate Second Reading Special Order - Passed with Amendments - Committee, Floor
12. April 25, 2025Introduced In Senate - Assigned to Appropriations