Medicaid audit process bill signed into law

OLYMPIA — Gov. Jay Inslee signed into law May 8 House Bill 1314, which establishes “a fair and predictable Medicaid audit process,” said Rep. Michelle Caldier, R-Port Orchard.

Caldier said the bill requires the Washington State Health Care Authority to meet specific standards related to auditing timelines, the recovery of payments, the use of statistical sampling and submission of records. It also establishes standards for contractors performing audits on behalf of the authority, the state legislator noted.

All health care providers in the state that accept Medicaid are subject to audit, Caldier’s news release stated. “Aggressive auditing practices have been a contributing factor in the decision by many providers to no longer accept Medicaid enrollees, which has made it more difficult for enrollees to find a local provider,” she said.

In a floor speech addressing the bill, Caldier detailed one case in which a dentist received a bill for $946,000 after the Medicaid authority uncovered a $10,000 billing error. Caldier, a former dentist who ran her own private practice, said audits are necessary, but believes the example is a case of government “gone wild.”

“People should have confidence (that) state agencies will treat them fairly and provide quality customer service,” she said. “I worked hard with the Authority to address the concerns of those in the medical community and reform the way Medicaid audits are conducted going forward.

House Bill 1314 was unanimously approved in the House and Senate before being signed into law by the governor. It will go into effect later this year, Caldier said.

Also signed into law:

Another bill by Caldier, House Bill 1444, also was signed by Gov. Inslee.

The bill, signed May 4, helps facilitate on-time grade level progression and graduation for at-risk youth. It also will require school districts to waive local graduation requirements and issue diplomas to qualifying students who enroll in three or more school districts throughout the year and still meet state graduation requirements. State law provides similar waivers for students of parents in the military.

As of 2015, homeless and foster youth had the lowest four-year and five-year graduation rates of all student groups in the state, Caldier said in a news release. Homeless students had a four-year graduation rate of 51.9 percent and five-year rate of 55.9 percent. Foster care students graduated at a four-year rate of 42.8 percent and five-year rate of 49.2 percent.

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