| Last Action | 03/27/19: became law without Governor's Signature (KY Acts ch. 176) |
|---|---|
| Title | AN ACT relating to durable medical equipment covered benefits and reimbursement under Medicaid. |
| Bill Documents |
Acts Chapter 176
Current/Final Introduced |
| Fiscal Impact Statements |
Fiscal Note
Additional Fiscal Impact Statements Exist |
| Bill Request Number | 852 |
| Sponsors | K. Moser, S. Sheldon, D. Bentley, A. Bowling, J. Graviss, M. Prunty, W. Thomas, L. Willner |
| Summary of Original Version | Create a new section of KRS Chapter 205 to establish definition of "durable medical equipment," to ensure that suppliers of durable medical equipment, prosthetics, orthotics, and supplies receive proper reimbursement of claims filed with prior authorization of service despite a Medicaid recipient moving to a different Medicaid managed care organization during the authorization period; require suppliers to be reimbursed at no less than 100% of the Kentucky Medicaid program durable medical equipment fee schedule; require items with miscellaneous HCPCS codes to be reimbursed at the manufacturer's suggested retail price minus 15% and those items without a manufacturer's suggested retail price reimbursed at invoice plus 20%; require Medicaid managed care organizations to cover the same quantities of medical supplies as are established on the Kentucky Medicaid program durable medical equipment fee schedule; require the allowable timeframe for claim submissions to be equal to the timeframe for any discrepancy during the Medicaid managed care organization's audit or recoupment period. |
| Index Headings of Original Version |
Medicaid - Durable medical equipment, claim filing, managed care organizations, prior service authorization Medicaid - Durable medical equipment, managed care organizations, recoupment period Fiscal Note - Durable medical equipment, managed care organizations, recoupment period |
| Jump to Proposed Amendments | Senate Floor Amendment 1 with Fiscal Impact Statements |
| Votes | Vote History |
| 02/05/19 |
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| 02/06/19 |
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| 02/12/19 |
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| 02/14/19 |
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| 02/15/19 |
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| 02/21/19 |
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| 02/22/19 |
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| 02/26/19 |
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| 03/05/19 |
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| 03/06/19 |
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| 03/13/19 |
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| 03/14/19 |
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| 03/26/19 |
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| 03/27/19 |
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| Amendment | Senate Floor Amendment 1 |
|---|---|
| Fiscal Impact Statement | Fiscal Note to Senate Floor Amendment 1 |
| Sponsor | R. Alvarado |
| Summary | Amend to expand the definition of "durable medical equipment" as well as to remove "repair and replacement parts" from the definition; decrease the rate at which managed care organizations (MCOs) reimburse for durable medical equipment; to limit subsection (2) to those healthcare codes and services included in Section 1903(i)(27) of Title XIX of the Social Security Act; delete the provision that prohibited the Department for Medicaid Services and MCOs from reviewing medical necessity for previously approved equipment, supplies, and services; delete the provision that required the Department for Medicaid Services to promulgate administrative regulations to ensure that prior service authorization would continue once granted at a minimum for the same amount, duration, and scope until the end of the authorization period as previously granted; change the amount that MCOs reimburse suppliers of durable medical equipment for manually priced items in the Medicaid program durable medical equipment fee schedule, by deleting the provision that requires that medical necessity criteria shall be made available to suppliers of durable medical equipment at no cost; add a subsection that provides that reimbursement for suppliers of durable medical equipment pursuant to this section shall only be available to in-network providers of the beneficiary's Medicaid MCO. |
| Index Headings |
Medicaid - Durable medical equipment, claim filing, managed care organizations, prior service authorization Medicaid - Durable medical equipment, managed care organizations, recoupment period Fiscal Note - Durable medical equipment, claim filing, managed care organizations, prior service authorization |
Last updated: 11/9/2023 3:08 PM (EST)