House Study Bill 743 - Introduced
HOUSE FILE _____
BY (PROPOSED COMMITTEE ON
WAYS AND MEANS BILL BY
CHAIRPERSON KAUFMANN)
A BILL FOR
1 An Act relating to reimbursement of providers by Medicaid
2 managed care organizations for items or services subject to
3 prior authorization.
4 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
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 H.F. _____
1 Section 1. NEW SECTION. 249A.14 Medicaid managed care
2 organizations —— reimbursement of providers for items or services
3 subject to prior authorization.
4 If a provider obtains any necessary prior authorization
5 from a Medicaid managed care organization for an item or
6 service furnished to a recipient, the Medicaid managed care
7 organization shall pay the provider one hundred percent of the
8 claim for reimbursement for the item or service, and shall
9 not seek repayment, offset against future reimbursement of
10 claims, or other payment or reimbursement from the recipient,
11 the provider, or any other source involved with the furnishing
12 of the item or service, unless the Medicaid managed care
13 organization determines the claim for reimbursement involves
14 fraud or misrepresentation.
15 EXPLANATION
16 The inclusion of this explanation does not constitute agreement with
17 the explanation’s substance by the members of the general assembly.
18 This bill relates to reimbursement of a provider by a
19 Medicaid managed care organization (MCO) for an item or service
20 subject to prior authorization.
21 The bill provides that if a provider obtains any necessary
22 prior authorization from an MCO for the furnishing of an item
23 or service to a recipient, the MCO shall pay the provider
24 100 percent of the claim for reimbursement for the item or
25 service, and shall not seek repayment, offset against future
26 reimbursement of claims, or other payment or reimbursement
27 from the recipient, the provider, or any other source involved
28 with the furnishing of the item or service, unless the MCO
29 determines the claim for reimbursement involves fraud or
30 misrepresentation.
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