Bill > HB538

This bill aims to improve the transparency and fairness of Medicaid managed care organizations (MCOs) by requiring them to provide more information on their websites, including contact details for provider relations and contract representatives, and clear explanations of their appeal processes. It also extends the timeframe for providers to file appeals or grievances related to claim reductions or denials from 60 to 120 days, and mandates that MCOs must resolve appeals within 30 days, with penalties for delays, including interest and attorney's fees on any owed payments. Furthermore, the bill establishes stricter standards for provider audits, requiring MCOs to use sampling methodologies for audit selection unless fraud is suspected, provide detailed written notification to providers about audits, and limit audit timeframes. It also mandates that MCOs report more comprehensive data on claims, appeals, and grievances to the Department for Medicaid Services, which in turn will submit an annual report to the Legislative Research Commission. Finally, the bill allows the Department for Medicaid Services to create necessary regulations and requires the Cabinet for Health and Family Services or the Department for Medicaid Services to seek federal approval if needed to implement these changes without jeopardizing federal funding.

Health and Social Services

https://apps.legislature.ky.gov/record/26RS/hb538.html