This bill amends K.S.A. 39-709h to enhance the requirements for managed care organizations (MCOs) providing services under the Kansas medical assistance program, specifically for KanCare and CHIP enrollees. A significant addition is the mandate that MCOs must provide an explanation of benefits to enrollees after healthcare services are rendered, starting January 1, 2028. This explanation must include details such as the enrollee's name and identification number, the healthcare provider's name, the billed amount, the allowed amount, and the amount paid by the Kansas medical assistance program. Additionally, the bill requires MCOs to offer quarterly training and education sessions for healthcare providers regarding billing guidelines and denial reasons.

The bill also introduces several provisions aimed at improving transparency and accountability in the claims process. It requires MCOs to document the reasons for claim denials and to resolve provider appeals within a specified timeframe. Furthermore, it establishes uniform standards for enrollment and credentialing processes, as well as grievance and appeal procedures. Notably, the bill repeals the previous requirement for the secretary to procure independent audits of claims, which is a significant change in oversight. Overall, the bill seeks to enhance communication between MCOs and healthcare providers while ensuring that enrollees receive clear information about their benefits.

Statutes affected:
As introduced: 39-709h