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HB 406/FN (BR 1154) - S. Nunn
AN ACT relating to medical assistance.
Amend KRS 211.461 to include definitions for "independent physician" and "independent physician review"; amend KRS 211.462 to allow Cabinet for Human Resources to revoke the registration of a private review agent; amend KRS 211.463 to require a private review agent to cooperate with all independent physician reviews of residents and patients; require appropriate documentation; include family members, next of kin and guardians in the group of individuals notified of action concerning a resident or patient; create a new section of KRS Chapter 205 to provide for continuation of benefits for any Medicaid beneficiary who receives an adverse determination as a result of review by a peer review organization; require that all appeals processes be exhausted prior to a final determination of level of care or the discontinuance of any public assistance benefits; require that an independent physician review be conducted along with input from the resident's or patient's attending physician prior to a final determination being made on appropriate level of care; set forth time frames for appeals processes up to and including the final decision of a hearing officer or officer of the court; amend KRS 216.535 to add a definition for "orientation manuals" to include information on owners and operators of facilities and information on staff physicians and nurses, staff complements on all shifts of operation, Medicaid eligibility and procedures for denial of benefits, procedures for implementation of peer review organization's utilization reviews and available appeals processes, and information on case managers and long-term care ombudsmen; create a new section of KRS Chapter 216 to require that all long-term care facilities licensed in the Commonwealth shall make available orientation manuals to all applicants and residents, and make the effective date for manual availability to be no later than 90 days after the effective date of the Act; create a new section of KRS Chapter 216B to require that all long-term care facilities in the Commonwealth which require a certificate of need shall make available orientation manuals to all applicants and residents and make the effective date for manual availability to be no later than the effective date of the Act.
HB 406 - AMENDMENTS
HCS/FN - Delete provision which amends KRS 211.461 for physician review agents and their contracts to include new definitions for "independent review physicians" and the requirement for appropriate documentation, and eliminate the requirement for the notification to family members, guardians and next of kin; delete the provision which amends KRS 216.535 to require the development and distribution of orientation manuals for long term care nursing facilities; delete the provisions which created new sections of both KRS Chapter 216 and KRS Chapter 216B which require all licensed long term care facilities and those long term care facilities which require a certificate of need, to make available orientation manuals no later than 90 days after the effective date of the Act; retain all provisions which create new sections of KRS Chapter 205 to provide for the continuation of benefits up to ninety (90) days from the date a notice of hearing has been received, for all Medicaid beneficiaries residing in a nursing facility or those eligible for Medicaid covered services if they have received an adverse determination concerning their level of care; adds requirement for a notification process which requires the peer review organization to notify the resident, nursing facility, commissioner of Medicaid Services and the resident's responsible party and attending physician by registered return receipt mail of a change in the level of care; requires a ten (10) day time frame for the notified individual to respond in writing and to appeal a change in the level of care; allow the attending physician to file an appeal on behalf of the Medicaid beneficiary if the registered return receipt mail is undeliverable to the resident's responsible party; requires that as long as the Medicaid beneficiary is engaged in any appeals process, all benefits will continue until such time as an appropriate residential setting is secured or until a final determination is made by a hearing officer; makes a technical correction by deleting a subsection where the context is repeated elsewhere in the Act.
Jan 23-introduced in House
Jan 26-to Health and Welfare (H)
Feb 6-posted in committee
Feb 20-reported favorably, 1st reading, to Calendar with Committee Substitute
Feb 23-2nd reading, to Rules
Feb 26-posted for passage in the Regular Orders of the Day for February 27, 1998
Mar 2-3rd reading, passed 91-0 with Committee Substitute
Mar 3-received in Senate
Mar 4-to Health and Welfare (S)
Mar 12-reported favorably, 1st reading, to Consent Calendar
Mar 13-2nd reading, to Rules
Mar 17-posted for passage in the Consent Orders of the Day for March 19, 1998
Mar 19-3rd reading, passed 38-0
Mar 20-received in House
Mar 23-enrolled, signed by each presiding officer, delivered to Governor
Mar 27-signed by Governor
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