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HCPF Statistical Sampling & Extrapolation

Concerning authorizing the department of health care policy and financing to use statistical sampling and extrapolation to recover overpayments to providers for certain medicaid services, and, in connection therewith, making and reducing an appropriation.

HB26-1412 2026 Regular Session Signed into Law Health Care & Health Insurance

Cost estimates

At the first note read
$0
FACT April 2, 2026
At the last note read
$0
FACT August 14, 2026
What it actually cost
not published
No Colorado source reports spending for one bill

Every figure here is an estimate by Legislative Council Staff on the date shown, about the version of the bill in front of them that day. It is not a cost.

The appropriation

The bill carries its own money. A note saying a bill “requires and includes” an appropriation means the money is in the bill itself.

An appropriation is money the legislature sets aside. It is not money spent.

The appropriation field, read from the note: For FY 2026-27, the bill requires and includes a net zero change in appropriations to the Department of Health Care Policy and Financing.

Bill summary

     If an audit of a medicaid provider who provides nonemergency medical transportation services or pediatric behavioral therapy is initiated after July 1, 2026, for services provided from January 1, 2022, through December 31, 2023, the act authorizes the department of health care policy and financing (HCPF) to determine and recover overpayments to a provider using statistical sampling and extrapolation. If an audit identifies a statistically significant pattern of alleged overpayments to a provider, the act authorizes the state auditor to use the same statistical sampling and extrapolation methods to audit services provided by the provider from January 1, 2024, through December 31, 2025.

     If the audit identifies an alleged overpayment, HCPF is required to issue a notice of the alleged overpayment within 60 days after the alleged overpayment is identified. The notice of alleged overpayment must include the basis of the alleged overpayment, the rationale for the alleged overpayment, the methodology used to calculate the alleged overpayment, and information on how HCPF identified the alleged overpayment.

     If HCPF enters into a contract for the purpose of conducting an audit, the contract must not be a contingency-based contract based on a percentage of the amount of recovery collected from the provider.

     After HCPF completes an audit of a provider, the state auditor's office is required to conduct an examination to determine that proper statistical sampling and extrapolation methods were used by HCPF when determining whether overpayments were made to a provider. The state auditor shall annually present a report of the findings to the legislative audit committee and the joint budget committee.

     The act reduces the general fund appropriation to HCPF for medical and long-term care services for Medicaid-eligible individuals by $6,861,775 and increases the cash fund appropriation to HCPF for medical and long-term care services for Medicaid-eligible individuals by $13,723,550.

FACT Bill summary by Colorado Legislative Council Staff, read 2026-09-23. Printed as published, word for word. Source: leg.colorado.gov (opens in a new tab)