Senate committee advances wide-ranging provider-integrity package after talks with providers

Senator Abler presented a delete‑all amendment to Senate File 42‑22 that blends provider-drafted language and sponsor changes aimed at strengthening program integrity while protecting providers' due process rights. The amendment was discussed at length and adopted as the A‑2 delete‑all.

Kevin Goodenow, representing the Community Provider Alliance, told the committee, “I'm Kevin Goodenow I'm here on behalf of the community provider alliance,” and said providers sought protections so that efforts to curb fraud, waste and abuse do not inadvertently shut down access to home- and community‑based services. Goodenow outlined the amendment’s major changes, including clarifying that Medicaid investigations are governed under chapter 256B and recodifying existing statute for readability.

A focal change is in section 10: the amendment raises the evidentiary threshold for temporary payment withholds to a preponderance of the evidence and limits most no‑notice payment withholds to 60 days, while adding more specific notice requirements so providers understand the basis for a withhold and can appeal. Goodenow summarized that change as aiming to balance “making payment withholds without prior notice” with judicial oversight and clearer notice so appeals are meaningful.

Other provisions the committee discussed include recodification of existing sanctions language, direction to the commissioner to study Medicaid enrollment standards and program-integrity technology (sections 15–18), creation of a program integrity advisory board (section 15), and a call for proportionate interventions so sanctions match the severity of any impropriety (section 19). The amendment also contains an appropriation provision for the attorney general’s office that the sponsor said may be removed and handled elsewhere.

Members asked technical and implementation questions. Senator Abler said the package keeps multiple policy options visible while they work with providers, the department and other stakeholders, and noted areas of incompatibility between provider proposals and other authors’ language that the two-article approach is intended to manage. Several senators expressed support for calibrating sanctions so that inadvertent billing errors are not treated as abuse.

After amendments were adopted on the floor of the committee, the sponsor said the measure will be refined in subsequent meetings and the A‑2 delete‑all was laid over for further work; the committee did not take a final passage vote on the underlying bill during this hearing.