ConnecticutMedicaid audits use estimates only above a claims threshold
Starting October 1, 2026, the law limits sample-based audit findings to cases above a claims threshold and requires billing help for reviews starting in 2027.
What it does
Auditors may base an overpayment or underpayment finding on a sample of claims only if the net estimated overpayment is more than 2.75% of the provider’s claims paid during the audit period. Providers whose rates are set under section 17b-340 are excluded.
The commissioner must make current billing guides and technical help available to assist providers with proper Medicaid billing before auditors use sampling and estimates.
Argument forBilling materials and technical help could help providers bill Medicaid correctly before auditors use estimates in reviews starting in 2027.
Argument againstProviders with smaller overpayments could be less likely to have them reflected in audit findings when auditors cannot use estimates below the threshold.
More detail
The law limits when an audit finding may rely on estimates from a sample of claims. It applies to findings of overpayment or underpayment for providers in the covered programs. The limit covers department programs under the listed statutes, except providers whose rates are set under section 17b-340. The net estimated overpayment must exceed 2.75% of the provider’s total claims paid during the audit period before a finding may rely on sampling and estimates. This rule takes effect October 1, 2026.
The commissioner must make billing education materials and technical assistance documents available to providers. The materials and documents are for providers seeking help with Medicaid billing. The materials must be current and help providers bill Medicaid correctly before auditors use sampling and estimates. This applies to audit review periods that begin on or after January 1, 2027.
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Where it stands
- Introduced
- Passed House
- Passed Senate
- To Governor
- Became Law
Looking ahead
No hearings or votes scheduled.
History
- 2026
- Jun 2SIGNED BY Governor Ned LamontBecame Law
- May 28TRANSMITTED BY SECRETARY OF THE STATE TO GOVERNORTo Governor
- May 28TRANSMITTED TO SECRETARY OF THE STATE
- May 20PUBLIC ACT 26-143
- May 6IN CONCURRENCE
- Vote recorded House Roll Call Vote. Result: pass.Lower
- Vote recorded Senate Roll Call Vote 392. Result: pass.Upper
- Vote recorded House Roll Call Vote 313. Result: pass.Lower
- May 6HOUSE PASSED, SEN. AMEND. SCH. AMajor
- May 6HOUSE PASSED, HOUSE AMEND. SCH. AMajor
- May 6HOUSE ADOPTED SEN. AMEND. SCH. AMajor
- May 6POTENTIAL DISAGREEING ACTION, TABLED CAL. HO.
- May 6TRANSMITTED PURSUANT TO JOINT RULE 17
- May 6SEN. PASSED, SEN. AMEND. SCH. AMajor
- May 6SEN. PASSED, HO. AMEND. SCH. APassed Senate
- May 6SEN. ADOPTED SEN. AMEND. SCH. AMajor
- May 6SEN. ADOPTED HO. AMEND. SCH. AMajor
- May 2SENATE CALENDAR NUMBER 519
- May 2FAV. RPT., TAB. FOR CAL., SEN.Minor
- May 1IMMEDIATE TRANSMITTAL TO THE SENATE
- Vote recorded House Roll Call Vote. Result: pass.Lower
- Vote recorded House Roll Call Vote 199. Result: pass.Lower
- May 1HOUSE PASSED, HOUSE AMEND. SCH. APassed House
- May 1HOUSE ADOPTED HOUSE AMEND. SCH. AMajor
- Apr 20TABLED FOR HOUSE CALENDARMinor
- Apr 20NO NEW FILE BY COMM. ON Finance, Revenue and Bonding
- Apr 20RPTD. OUT OF LCO
- Apr 20FILED WITH LCOMinor
- Apr 20Joint FavorableMinor
- Apr 14REF. BY HOUSE TO COMMITTEE ON Finance, Revenue and Bonding
- Apr 7FILE NO. 413
- Apr 7HOUSE CALENDAR NUMBER 297
- Apr 7FAV. RPT., TABLED FOR HOUSE CALENDARMinor
- Apr 7RPTD. OUT OF LCO
- Mar 30REFERRED TO Office of Legislative Research AND Office of Fiscal Analysis 04/07/26Minor
- Mar 20FILED WITH LCOMinor
- Mar 19Joint Favorable SubstituteMinor
- Feb 27PUBLIC HEARING 0303
- Feb 26REF. TO JOINT COMM. ON Human ServicesIntroduced
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