HB 69 Kentucky House · 2018 Regular Session

AN ACT relating to service delivery improvements in managed care networks. Create new sections of KRS Chapter 205 to define terms; establish and require that the Department for Medicaid Services designate a single credentialing verification organization to verify credentials for DMS and all contracted Medicaid Managed Care Organizations; submit the credentialing organization to Government Contract Review Committee for comment; require providers to submit a single application to the credentialing organization; require notification within 5 days to the provider if application is complete; require verified packets be sent to the DMS and MCOs within 30 days; require DMS to enroll providers within 15 days and for the MCOs to determine if they will contract with the provider within 15 days; specify that for reimbursement of claims purposes the date of the submission of the credentialing application shall be the date of original enrollment and credentialing; address the written internal appeals process of MCOs; require 24/7 utilization reviews and daily staffing for claims resolution; establish grievance and appeal timeline and written appeal requirements; require reprocessing of incorrectly paid or erroneously denied claims; allow for in-person meetings for unpaid claims beyond 45 days and that individually or in the aggregate exceed $2,500; require consistency and timeliness between physical, behavioral, or other medically necessary services; establish timelines for preauthorization requests; require that substance use disorder be treated as an urgent preauthorization request; require a single nationally recognized clinical review criteria for both physical health and behavioral health services; establish monthly reporting requirements for MCOs relating to claims; require reporting between the DMS and the Department of Insurance; establish penalties for MCOs that fail to comply; prohibit automatic assignment of Medicaid enrollees to an MCO unless there is a participating acute care hospital within the distance requirements; allow for enrollees to change MCOs outside of the open enrollment if their hospital or PCP terminates participation with an MCO; amend KRS 304.17A-515 to require each managed care plan to demonstrate that it offers physically available acute care hospital services; amend KRS 304.17A-576 to require a response about credentialing within 45 instead of 90 days; amend KRS 304.17A-700 to reference Section 1 of the bill.

Bill status signed all 5 stages cleared
Introduction
Nov 2017
Committee Review
Mar 2018
House Passage
Mar 2018
Senate Passage
Mar 2018
Signed into Law
Apr 2018
Introduced Nov 29, 2017 Signed Apr 4, 2018
Floor votes

How they voted

This bill passed the House by voice vote (no roll call recorded).
Full legislative history

Actions timeline

Total actions
29
Key actions
5
Committee
6
Amendments
2
Apr 2, 2018
Introduced
Filed without Governor's signature with the Secretary of State
lower
Mar 21, 2018
Lower · Passed
Passed 91-1
lower
Mar 21, 2018
Lower · Passed
House concurred in Senate Committee Substitute and floor amendment (1)
lower
Mar 21, 2018
Lower · Passed
Posted for passage for concurrence in Senate Committee Substitute and floor amendment (1)
lower
Mar 20, 2018
Committee
To Rules (H)
lower
Mar 16, 2018
Introduced
Floor amendment (1) filed to Committee Substitute
lower
Mar 16, 2018
Lower · Passed
Passed over and retained in the Orders of the Day
lower
Feb 26, 2018
Committee
To Health & Welfare (S)
upper
Feb 21, 2018
Introduced
Floor amendment (1) filed to Committee Substitute
lower
Jan 31, 2018
Lower · Passed
Posted in committee
lower
Jan 2, 2018
Committee
To Banking & Insurance (H)
lower
Jan 2, 2018
Introduced
Introduced in House
lower
Nov 29, 2017
Introduced
Prefiled by the sponsor(s).
lower
0 primary · 0 co-sponsors

Sponsors

No sponsor information available.