Kentucky
General Assembly

02/13/25	introduced in Senate to Committee on Committees (S)
02/18/25	to Health Services (S)
02/26/25	reported favorably, 1st reading, to Calendar with Committee Substitute (1)
02/27/25	2nd reading, to Rules
02/28/25	posted for passage in the Regular Orders of the Day for Tuesday, March 04, 2025
03/04/25	passed over and retained in the Orders of the Day floor amendment (1) filed to Committee Substitute
03/05/25	3rd reading, passed 37-0-1 with Committee Substitute (1) and Floor Amendment (1)
03/06/25	received in House to Committee on Committees (H)
03/11/25	to Health Services (H)
03/12/25	reported favorably, 1st reading, to Calendar with Committee Substitute (1) and Committee Amendment (1-title)
03/13/25	2nd reading, to Rules

Amendment	Senate Committee Substitute 1
Summary	Retain original provisions, except delete provisions related to the timeframe for which a Medicaid-enrolled provider may be subject to prepayment claims review.
Index Headings	Physicians and Practitioners - Medicaid managed care, utilization of prepayment claims review, limitations, establishment Public Medical Assistance - Managed care organizations, prepayment claims review standards, establishment Medicaid - Managed care organizations, prepayment claims review standards, establishment Administrative Regulations and Proceedings - Department for Medicaid Services, prepayment claims review

Amendment	Senate Floor Amendment 1
Sponsor	C. Richardson
Summary	Retain original provisions and establish that requirements for prepayment claims review shall only be enforceable to the extent permitted under federal law and shall not apply to a Medicaid-enrolled provider who has been placed on a stand-down list by the Medicaid Fraud Control Unit or the Attorney General.
Index Headings	Attorney General - Medicaid prepayment claims review, stand-down list exception, establishment Medicaid - Prepayment claims review, stand-down list exception, establishment

Amendment	House Committee Substitute 1
Summary	Retain original provisions; 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 2 of this Act, 42 U.S.C. sec. 1396u-2, or 42 C.F.R. pt. 438 Subpart K; 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 of 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% 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; require the Cabinet for Health and Family Services or the Department for Medicaid Services to seek federal approval if they determine that such approval is necessary and comply with KRS 205.525.
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 managed care, utilization of prepayment claims review, limitations, establishment 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 - 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 Public Medical Assistance - Managed care organizations, prepayment claims review standards, establishment 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 - 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 Medicaid - Managed care organizations, prepayment claims review standards, establishment Administrative Regulations and Proceedings - Cabinet for Health and Family Services, accreditation and licensing, substance use treatment Administrative Regulations and Proceedings - Department for Medicaid Services, prepayment claims review Administrative Regulations and Proceedings - Department for Medicaid Services, provider audits, authorizaton Reports Mandated - Department for Medicaid Services, annual report, Medicaid claims, requirement

Amendment	House Committee Amendment 1
Sponsor	K. Moser
Summary	Make title amendment.
Index Headings	Title Amendments - SB 153/GA