| Last Action | 03/07/25: 2nd reading, to Rules |
|---|---|
| Title | AN ACT relating to the Medicaid program. |
| Bill Documents | Introduced |
| Bill Request Number | 1573 |
| Sponsors | K. Moser, L. Willner |
| Summary of Original Version | Create new sections of KRS Chapter 205 to define terms; establish limitations on material changes to contracts between Medicaid managed care organizations and Medicaid-participating providers; require contracts between the Department for Medicaid Services and a managed care organization to comply with federal laws related to mental health parity; require behavioral health programs to be accredited and narcotic treatment programs to be licensed in order to be eligible for Medicaid reimbursement; amend KRS 205.522 to require the Department for Medicaid Services and managed care organizations to comply with KRS 304.17A-661 related to treatment of mental health conditions and 304.17A-700 to 304.171A-730 related to payment of claims; require managed care organizations to provide a description of reasons for denial when payment of a claim is denied; amend KRS 304.38-130 to authorize the commissioner of the Department of Insurance to suspend or revoke a Medicaid managed care organization's certificate of authority for willful or frequent and repeated failure to comply with Section 1 of this Act, 42 U.S.C. sec. 1396u-2, or 42 C.F.R. pt. 438 Subpart K. |
| Index Headings of Original Version |
Mental Health - Behavioral health and substance use disorder treatment, parity, requirement Mental Health - Chemical dependency treatment program, accreditation, Medicaid reimbursement, requirement Public Medical Assistance - Behavioral health and substance use disorder treatment, parity, requirement Public Medical Assistance - Chemical dependency treatment program, accreditation, Medicaid reimbursement, requirement Public Medical Assistance - Managed care organization provider contracts, material changes, limitations, establishment Public Medical Assistance - Managed care organization, certificate of authority, revocation or suspension, authorization State Agencies - Cabinet for Health and Family Services, administrative regulations, substance use treatment programs State Agencies - Department of Insurance, certificate of authority managed care, revocation or suspension, authorized Substance Abuse - Behavioral health and substance use disorder treatment, parity, requirement Substance Abuse - Narcotic treatment program, licensing, Medicaid reimbursement, requirement Medicaid - Behavioral health and substance use disorder treatment, parity, requirement Medicaid - Chemical dependency treatment program, accreditation, Medicaid reimbursement, requirement Medicaid - Managed care organization provider contracts, material changes, limitations, establishment Medicaid - Managed care organization, certificate of authority, revocation or suspension, authorization Administrative Regulations and Proceedings - Cabinet for Health and Family Services, accreditation and licensing, substance use treatment |
| Jump to Proposed Amendments | House Committee Substitute 1 |
| 02/19/25 |
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|---|---|
| 02/27/25 |
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| 03/06/25 |
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| 03/07/25 |
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| Amendment | House Committee Substitute 1 |
|---|---|
| Summary | Retain original provisions; amend KRS 205.533 to require Medicaid managed care organizations to include certain information for providers on their websites; amend KRS 205.534 to require managed care organizations to allow providers 120 days to file an appeal or grievance related to a reduction or denial of a claim; establish penalties for a managed care organization's failure to ensure the timely disposition of any appeal or grievance; require payment of any amount owed to a provider following an appeal to be paid within 30 days; require payments made following an appeal to include 12 percent interest and reasonable attorney's fees; establish standards and requirements for provider audits; require the inclusion of additional information in the monthly report filed by managed care organizations; require the Department for Medicaid Services to submit an annual report to the Legislative Research Commission related to Medicaid claims, appeals, and grievances; authorize the Department for Medicaid Services to promulgate administrative regulations; create a new section of KRS Chapter 205 to require the Department for Medicaid Services and Medicaid managed care organizations to cover at least two evaluation and management service units per physician, per recipient, per date of service; require the Cabinet for Health and Family Services or the Department for Medicaid Services to seek federal approval, if necessary, and to comply with notice requirements. |
| Index Headings |
Health and Medical Services - Medicaid, managed care organization provider audits, requirements Mental Health - Behavioral health and substance use disorder treatment, parity, requirement Mental Health - Chemical dependency treatment program, accreditation, Medicaid reimbursement, requirement Physicians and Practitioners - Medicaid, coverage for evaluation and management services, requirement Physicians and Practitioners - Medicaid, managed care organization provider audits, requirements Public Medical Assistance - Behavioral health and substance use disorder treatment, parity, requirement Public Medical Assistance - Chemical dependency treatment program, accreditation, Medicaid reimbursement, requirement Public Medical Assistance - Coverage for evaluation and management services, requirement Public Medical Assistance - Managed care organization provider audits, requirements Public Medical Assistance - Managed care organization provider contracts, material changes, limitations, establishment Public Medical Assistance - Managed care organization, certificate of authority, revocation or suspension, authorization State Agencies - Cabinet for Health and Family Services, administrative regulations, substance use treatment programs State Agencies - Department for Medicaid Services, annual report, requirement State Agencies - Department for Medicaid Services, promulgation of administrative regulations, authorization State Agencies - Department of Insurance, certificate of authority managed care, revocation or suspension, authorized Substance Abuse - Behavioral health and substance use disorder treatment, parity, requirement Substance Abuse - Narcotic treatment program, licensing, Medicaid reimbursement, requirement Medicaid - Behavioral health and substance use disorder treatment, parity, requirement Medicaid - Chemical dependency treatment program, accreditation, Medicaid reimbursement, requirement Medicaid - Coverage for evaluation and management services, requirement Medicaid - Managed care organization provider audits, requirements Medicaid - Managed care organization provider contracts, material changes, limitations, establishment Medicaid - Managed care organization, certificate of authority, revocation or suspension, authorization Administrative Regulations and Proceedings - Cabinet for Health and Family Services, accreditation and licensing, substance use treatment Administrative Regulations and Proceedings - Department for Medicaid Services, provider audits, authorization Reports Mandated - Department for Medicaid Services, annual report, Medicaid claims, requirement |
Last updated: 3/7/2025 4:31 PM (EST)