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SB 279 (BR 1819) - K. Stine, E. Worley, B. Jackson, R. Roeding, J. Westwood
AN ACT relating to health insurance.
Establish a new Subtitle 17B of KRS Chapter 304, and create new sections to define terms including "claims payment time frame" and "clean claim"; establish a time frame for insurers to reimburse a provider or to send written notice denying or contesting the claim; establish procedures for receiving claims, informing providers of the status of claims, and providing claims information; establish the procedure to follow for contested claims; address miscalculations in payments made by insurers; require certain disclosures by insurers in the provider manual regarding processing procedures; create to require written notice to provider if services provided are not covered or person was not eligible for coverage; establish procedure if an insurer chooses to collect an overpayment through recoupment against future provider payments; establish procedure if an insurer does not provide a representative who is authorized to review and approve preauthorization of covered services on weekend, holidays, or after normal business hours; set forth procedure to apply if an insurer intends to audit a claim; require an insurer to include certain information on the covered person's identification card; require an insurer to issue a new provider number under certain circumstances; require the commissioner to promulgate administrative regulations regarding standardized health claim attachments; require the department to promulgate administrative regulations requiring insurers to report certain information at least annually to insure compliance with this Act; to state application of Act extends to any entity an insurer contracts with to perform claims processing functions; require outstanding claims and future contractual agreements between insurers and providers to conform to this Act; prohibit silent PPOs; establish an interest provision; establish penalties; and amend KRS 304.14-135 to conform.
SB 279 - AMENDMENTS
SCS - Establishes a new Subtitle 17B of KRS Chapter 304, and create new sections to define terms and to set forth the specific forms to be used by providers, pharmacists, and dentists regarding the filing of claims; to set the claims payment timeframe at thirty (30) calendar days following receipt of electronic or paper claims, except sixty (60) days allowed for claims involving organ transplants; to require insurers to acknowledge receipt of electronic claims within thirty-eight (38) hours and other claims within twenty (20) calendar days and to require that claims that do not contain errors must be acknowledged electronically or in writing to the provider that submitted the claim, and the date that the claims were received, on a file that can be accessed electronically by the provider, to require insurers to have a mechanism for providers to check on claims status electronically following submission of the claims to the insurer by January 1, 2001; to limit payment delays to a clean claim to specific situations including if the premium has not been paid, and to require a sixty (60) day prior written notice to providers from insurers if modifications are made to the provider manual that materially changes the type or content of the attachments to be submitted; to require insurers to correct payment errors within thirty (30) calendar days of notice, to allow providers twenty-four (24) months from the date they received insurer payment to require that errors be corrected and limits insurer retroactive denial of provider reimbursement to twenty-four (24) months following the date that the provider's claim was paid unless there is fraud; to require insurers to notify contracted providers of the mailing or electronic address for claims processing and to give thirty (30) days written notice of address changes; to require insurers to request a refund to make a recoupment for payments made for noncovered services or for individual not eligible for coverage; to require insurers to give specific information to a provider if they recoup overpayments by taking a deduction against future provider payments, to require an insurer to collect an overpayment within twenty-four (24) months from acknowledgment of claim; to require payment when an insurer fails to conduct a utilization review; to require that a covered person receive an identification card with the mailing address for claims and the type of coverage on the card; to require the standardization of health claim attachments; to require the Department of Insurance to audit compliance of insurers and to annually report to the Interim Joint Committee on Banking and Insurance and to the Governor on insurer compliance and enforcement activities; to clarify applicability of this Act to certain entities; to require that claims incurred or received after the effective date of this Act and contractual agreements entered into after the effective date of this Act to conform to this Act; to require a provision identifying products and markets that may be discounted per a contract with a provider, an organization of providers, or a PPO network of preferred providers; to require an insurer that fails to pay, deny, or settle a clean claim to pay interests from the date that the claim was received; to define "noncompliance," to enumerate penalties; and to amend KRS 304.14-135 to conform.
SFA (1, T. Buford) - Change the definition of health care provide to include physical therapists licensed under KRS Chapter 327.
SFA (2, K. Stine) - Establish a new Subtitle 17B of KRS Chapter 304, and create new sections to define terms including "adjudicate" and "electronic" and to set forth the specific forms to be used by providers, pharmacists, and dentists regarding the filing of claims; to set the claims payment timeframe at thirty (30) calendar days following receipt of electronic or paper claims, except sixty (60) days allowed for claims involving organ transplants; to require insurers to acknowledge receipt of electronic claims within forty-eight (48) hours and other nonelectronic claims within twenty (20) calendar days and to require that claims that do not contain errors must be acknowledged electrically or in writing to the provider, billing agent, or designee that submitted the claims, and the date that the claims were received on a file that can be accessed electronically by the provider, to require insurers to have a mechanism for providers to check on claims status electronically following submission of the claims to the insurer by January 1, 2001; to limit payment delays to a clean claim to specific situations including if the premium has not been paid by a group or an individual, and to require a sixty (60) day prior written notice to providers from insurers if ,modifications are made to the provider manual that materially changes the type or content of the attachments to be submitted; to require insurers to correct payment errors within thirty (30) calendar days of notice, to allow providers twenty-four (24) months from the date they received insurer payment to require that errors be corrected and limits insurer retroactive denial of provider reimbursement to twenty-four (24) months following the date that the provider's claim was paid unless there is fraud; to require insurers to notify contracted providers of the mailing or electronic address for claims processing and to give thirty (30) days written notice of address changes; to require insures to request a refund to make a recoupment for payments made for noncovered services or for individuals not eligible for coverage; to require insurers to give specific information to a provider if they recoup overpayments by taking a deduction against future provider payments, to require an insurer to collect an overpayment within twenty-four (24) months from the date that the insurer paid the claim; to require payment when an insurer fails to conduct a utilization review; to require that a covered person receive an identification card with the mailing address for claims and the type of coverage on the card; to require the standardization of health claims attachments; to require insurers to submit data on the percentage of clean claims paid within the proper timeframe, the percentage or clean claims paid after the proper timeframe for providers, excluding pharmacies, within which the claims were finally adjudicated and reported in 31 to 60, 61 to 90 and in excess of 90 day intervals; to require the Department of Insurance to audit compliance of insurers and to annually report to the Interim Joint Committee on Banking and Insurance and to the Governor on insurer compliance and enforcement activities; to clarify applicability of this Act to certain entities; to require that claims incurred or received after the effective date of this Act and contractual agreements entered into after the effective date of this Act to conform to this Act; to require a provision identifying products and markets that may be discounted per a contract with a provider, an organization of providers, or a PPO network of preferred providers; to require an insurer that fails to pay, deny, or settle a clean claim to pay interest from the date that the claim was received; to establish activity that demonstrates compliance, to enumerate penalties; and to amend KRS 304.14-135 and 205.593 to conform.
HCS - Retain original provisions and delete physical therapists from the definition of health care provider; make technical change to create new sections of Subtitle 17A of KRS Chapter 304 rather than establish a new Subtitle 17B of KRS Chapter 304.
HFA (1, H. Collins) - Amend to require health benefit plans to provide coverage for treatment of a congenital condition and to define "congenital condition".
HFA (2, R. Damron) - Amend to include physical therapist in the definition of provider solely for the purposes of this Act.
HFA (3, T. Burch) - Delete exclusion of individuals eligible for certain Medicare programs from coverage in the individual market.
HFA (4, M. Marzian) - Retain original provisions and require Medicaid's Early and Periodic Screening Diagnosis and Treatment screening form be used for reimbursement.
HFA (5, M. Treesh) - Create a new section of KRS Chapter 315 to prohibit a pharmacist who states in writing an objection to dispensing medication that may terminate a pregnancy from being held liable for the objection; prohibit discrimination against a pharmacist who objects to dispensing medication that may terminate a pregnancy.
HFA (6/Title, M. Treesh) - Make title amendment.
Feb 16-introduced in Senate
Feb 18-to Banking and Insurance (S)
Feb 29-reported favorably, 1st reading, to Calendar with Committee Substitute
Mar 1-2nd reading, to Rules
Mar 6-floor amendment (1) filed to Committee Substitute
Mar 7-posted for passage in the Regular Orders of the Day for Thursday, March 9, 2000
Mar 8-floor amendment (2) filed to Committee Substitute
Mar 9-3rd reading, passed 37-0 with Committee Substitute, floor amendments (1) and (2)
Mar 10-received in House
Mar 13-to Banking and Insurance (H)
Mar 15-posting waived; posted in committee
Mar 16-reported favorably, 1st reading, to Calendar with Committee Substitute
Mar 17-2nd reading, to Rules; floor amendments (1) and (2) filed to Committee Substitute
Mar 20-floor amendment (3) filed to Committee Substitute
Mar 21-floor amendment (3) withdrawn ; floor amendment (4) filed to Committee Substitute
Mar 22-posted for passage in the Regular Orders of the Day for Thursday, March 23, 2000; floor amendment (4) withdrawn ; floor amendment (5) filed to Committee Substitute, floor amendment (6-title) filed
Mar 23-floor amendments (5) and (6-title) withdrawn
Mar 24-3rd reading, passed 95-0 with Committee Substitute, floor amendment (2)
Mar 27-received in Senate
Mar 29-posted for passage for concurrence in House Committee Substitute, floor amendment (2) ; taken from the Regular Orders of the Day, placed in the Consent Orders of the Day; Senate concurred in House Committee Substitute, floor amendment (2) ; passed 37-0
Apr 11-enrolled, signed by each presiding officer, delivered to Governor
Apr 21-signed by Governor (Acts ch. 436)
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