SB 178 (BR 1336) - B. Leeper, J. Bowen, M. Wilson
AN ACT relating to an entity with a valid license issued by the Department of Insurance to operate as a health maintenance organization or insurer that operates a Medicaid managed care organization.
Create a new section of KRS Chapter 205 to establish Medicaid managed care organization requirements for determination of an emergency medical condition and a non-emergency condition based on the provider's determination, coverage of emergency services in a non-network hospital, prohibit preauthorization for admission of an enrollee with a psychiatric emergency medical condition for stabilization as determined by the treating physician; amend KRS 205.222 to require a Medicaid managed care organization to comply with the provisions of KRS 304.17A-600, 304.17A-607, 304.17A-609, 304.17A-611, 304.17A-617, and 304.17A-619 and establish compliance requirements; authorize an enrollee to assign any rights to a challenge or appeal of an adverse action by a Medicaid managed care organization concerning coverage or payment for health care services; authorize an appeal of an adverse action by a Medicaid managed care organization to an administrative hearing officer with an order required within 30 days of the hearing, subject to judicial review, and require the Medicaid managed care organization to reimburse reasonable attorney fees and costs if the enrollee or provider prevails on the merits; create a new section of KRS Chapter 205 to require a Medicaid managed care organization which receives a capitation payment for retroactive eligibility to perform a retrospective review of the necessity for a medical service performed during a period of retroactive eligibility if utilization review is required and the Medicaid managed care organization receives a timely request for a review in accordance with Department for Medicaid Services administrative regulations; create a new section of KRS Chapter 205 to require a Medicaid managed care organization to manage and administer Medicaid benefits in accordance with insurance code provisions KRS 304.17A-500 to 304.17A-661, if not in conflict with federal Medicaid law, when a Medicaid managed care organization seeks certification as a qualified health plan under a health benefit exchange established in compliance with the federal Affordable Care act; repeal KRS 205.6310 and amend KRS 205.6328, 205. 6334, and 205.6336 to conform.
Feb 15-introduced in Senate
Feb 22-to Health & Welfare (S)
Feb 27-reported favorably, 1st reading, to Calendar
Feb 28-2nd reading, to Rules