Committee advances bill limiting insurers' retroactive recoupments to 18 months

The House Commerce and Energy Committee on Thursday voted 12–1 to advance House Bill 12‑92 as amended, a measure that would limit how far back a health‑care carrier may retroactively recoup funds for claims already paid and require notice to providers before recoupment.

Representative Melissa Herrmann, sponsor of the bill, told the committee the amendment narrows the measure to focus on an 18‑month look‑back period and removes additional procedural steps used in other states so the law centers on predictability and fairness for providers.

"House Bill 12‑92 as amended is a narrowly tailored bill," Herrmann said, describing the proposal as designed to give providers "reasonable certainty that once a claim is paid, it will not be endlessly reopened without clear justification." She noted the bill includes a carve‑out for fraud, abuse and waste.

Provider witnesses told the committee the change is needed. Christine Papana, vice president of value‑based care and employee health plan administration at Monument Health, said current payer policies often allow insurers to recoup without advance notice and impose unlimited look‑back windows in practice.

"House Bill 12‑92 introduces 2 very reasonable protections," Papana said. "First, it requires payers to notify providers before recouping funds and second, it limits the look back period to 18 months from the date of payment." She described the administrative burden of identifying, reconciling and appealing recoupments years after the payment was made.

Additional supporters — including representatives of Sanford Health and Avera — associated themselves with Papana's testimony, saying the measure balances provider stability and patient protection.

There were no opponents who signed up to testify. Committee discussion focused on whether the bill addressed overbilling only (the sponsor and witnesses said it does) and on operational questions about how underbilling is handled in practice.

Representative Baumler moved a "due pass" recommendation; after a roll call the committee reported the bill as passing with 12 ayes and 1 nay. The committee's action sends the amended bill forward under the Legislature's process for further consideration.

Next steps: House Bill 12‑92 as amended will proceed through the legislative process for scheduling and additional floor consideration.