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HB 118/FN (BR 81) - G. Stumbo, T. Riner, G. Brown Jr., L. Clark, J. Glenn, D. Horlander, R. Nelson, R. Rand, D. Watkins, J. Wayne

     AN ACT relating to the Medicaid Provider appeals and declaring an emergency.
     Create a new section of KRS Chapter 205 to clarify how distance is calculated by a medicaid managed care organization (MCO); create new sections of KRS Chapter 205 to define terms; clarify that a medical loss ratio (MLR) is calculated as long as it supplements federal law; require the minimum MLR for an MCO to be equal to or higher than 85% for each year; establish requirements for the numerator and denominator of the MLR; require a remittance for a MLR if the 85% standard is not met; establish an attestation of accuracy and require submission of certain data; require recalculation of the MLR when a retroactive change is made to a capitation payment; prohibit bonus or incentive payments to providers or subcontractors based on whether the MLR is met or exceeded; require submission to the Department of Medicaid Services of supplemental financial schedules to reconcile expense reports; establish timeframe for submission of supplemental financial schedules; amend KRS 304.17A-730 to require the commissioner of the Department of Insurance (DOI) to enforce Kentucky's prompt payment laws as they relate to disputes between the providers of care to Medicaid recipients and Medicaid Managed care organizations and Medicaid recipients and the MCOs; allow a Medicaid recipient or provider to file a claim with the DOI for a failure to comply with Kentucky's prompt payment statutes; allow a hearing to be requested when the claim is denied or after 30 days of nonpayment; allow a hearing to be requested for a claim designated as "less than clean" after 120 days of nonpayment; allow multiple claims to be reviewed in one complaint; allow the DOI to charge a filing fee to cover its reasonable expenses; allow the DOI to investigate issues arising through the report process; require eligible claims to be filed within 30 days, require a ruling within 30 days if no hearing is held and 60 days if a hearing is held; encourage reporting form documents be forwarded to State Auditor for review; exempt fee-for-service Medicaid; permit interest rate of 14% to be charged for nonpayment and provide for additional penalties for nonpayment; require the commissioner of the DOI authority to enforce Kentucky's prompt payment laws as they relate to disputes between the DMS, Medicaid recipients, providers of care to Medicaid recipients, or a managed care company contracting with the DMS to provide care to Medicaid recipients; require the DOI to establish an internal appeals and hearing process for review of prompt payment claims; guarantee that currently existing unpaid "clean" or "less than clean" claims or any claims that arise after the effective date of the bill and before the implementation of hearing regulations shall be guaranteed interest payments and that each day shall continue to count as a separate violation even without a hearing process established; amend KRS 304.17A-722 to require additional reporting of original and corrected claims and pharmacy claims administered by insuurers; EMERGENCY.


     HCS1/FN - Delete original provisions; create new sections of KRS Chapter 205 to define terms, and permit a provider that has exhausted an internal appeals process of a Medicaid managed care organization (MCO) to be entitled to an administrative appeals hearing; require an MCO to send a final determination letter; establish proceedings for an administrative appeals hearing and require the CHFS to conduct the administrative hearing; establish a mechanism for attorneys' fees; establish a $250 fee for the party that does not prevail to cover costs of the proceeding; clarify that this bill applies to all MCO contracts enacted on or after July 1, 2016; amend KRS 13B.020 to include the provider appeals process as a type of administrative hearings to be conducted by the CHFS; declare an EMERGENCY.
     HCA1( T. Burch ) - Make title amendment.

     Dec 10, 2015 - Prefiled by the sponsor(s).
     Jan 05, 2016 - introduced in House; to Health & Welfare (H)
     Jan 15, 2016 - posted in committee
     Jan 28, 2016 - reported favorably, 1st reading, to Consent Calendar with Committee Substitute (1) and committee amendment (1-title)
     Jan 29, 2016 - 2nd reading, to Rules; taken from Rules (H); placed in the Consent Orders of the Day for Monday, February 1
     Feb 01, 2016 - 3rd reading, passed 92-0 with Committee Substitute (1), committee amendment (1-title)
     Feb 02, 2016 - received in Senate
     Feb 04, 2016 - to Appropriations & Revenue (S)