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SB 166/FN (BR 1877) - B. Leeper, W. Blevins Jr., M. Wilson

     AN ACT relating to Medicaid managed care organization provider payments.
     Amend KRS 205.522 to define terms; permit an enrollee of a medicaid managed care organization (MCO) to assign rights to appeal an action by an MCO relating to care received by an enrollee; establish an enrollee's right to a state fair hearing when an enrollee or assignee appeals an MCO's action relating to care received or proposed to be given to an enrollee; require an action by an MCO to state the reason for an action with specificity; state that the MCO shall pay for services rendered while an appeal was pending if a hearing officer reverses a decision to deny, reduce, or terminate health care services.


     SCS/FN - Retain original provisions except make a hearing officer's ruling subject only to judicial appeal following a state fair hearing conducted pursuant to the bill, and state that any subject may be addressed in a state fair hearing and require compliance with a federal regulation when a decision to deny authorization of services is reversed.
     SFA (1, B. Leeper) - Retain provisions of the SCS, however require the agency head to issue a final order within 25 days or the hearing officer's opinion will become final; require an MCO to pay for all disputed services and interest within 30 days upon exhaustion of all appeals.

     Feb 26-introduced in Senate
     Feb 28-to Appropriations & Revenue (S)
     Mar 12-reported favorably, 1st reading, to Calendar with Committee Substitute
     Mar 13-2nd reading, to Rules
     Mar 18-floor amendment (1) filed to Committee Substitute

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