HB 1191

Bill Subjects

Agencies; Family And Social Services Administration (Fssa) Civil Law And Procedure; Contracts And Legal Documents General Assembly; Generally Health; Medicaid Insurance; Health Insurance Insurance; Health Maintenance Organizations (Hmos) Public Hearings And Meetings Task Forces And Committees; Generally

Abstract

Allows a provider that has entered into a contract with a managed care organization, after exhausting any internal procedures of the managed care organization for provider grievances and appeals, to request an independent review of the managed care organization's action with an independent third party provider selected by the office of Medicaid policy and planning. Establishes a procedure for an independent third party provider to review an action of a managed care organization. Prohibits a provision in a contract between a provider and a managed care organization that would negate or restrict the right of a provider to an independent review and provides that such a contract provision is void and unenforceable. Provides that if the office of the secretary of family and social services (office) or a contractor of the office fails to pay or denies a clean claim for any eligible Medicaid service within certain time limits due to the office or contractor incorrectly processing the clean claim because of errors attributable to the internal system of an insurer or managed care organization, the office or contractor may not assert that the provider failed to meet the timely filing requirements for the claim. Changes the membership of the Medicaid advisory committee (committee). Allows a member of the committee whose position was eliminated to continue to serve until the member's term expires. Establishes co-chairs for the committee and provides that the elected co-chair of the committee serves for a two year term. Requires the office to prepare a report that describes every type of report that must be prepared by a Medicaid contractor or managed care entity and submitted to the office or the office of Medicaid policy and planning. Specifies the information that must be contained in the report. Requires the office to submit the report to the committee and the general assembly. Requires the committee to hold public hearings on the report. Makes technical changes.