Summary of Original Version

Create a new section of KRS Chapter 205 to define terms and to establish standards for the utilization of prepayment claims review in the Medicaid program; require the Cabinet for Health and Family Services or the Department for Medicaid Services to seek federal approval if they determine that such approval is necessary and comply with KRS 205.525.

Summary of Amendment: Senate Committee Substitute 1

Summary Retain original provisions, except delete provisions related to the timeframe for which a Medicaid-enrolled provider may be subject to prepayment claims review.

Summary of Amendment: Senate Floor Amendment 1 -- C. Richardson

Summary Retain original provisions and establish that requirements for prepayment claims review shall only be enforceable to the extent permitted under federal law and shall not apply to a Medicaid-enrolled provider who has been placed on a stand-down list by the Medicaid Fraud Control Unit or the Attorney General.

Summary of Amendment: House Committee Substitute 1

Summary Retain original provisions; create new sections of KRS Chapter 205 to define terms; establish limitations on material changes to contracts between Medicaid managed care organizations and Medicaid-participating providers; require contracts between the Department for Medicaid Services and a managed care organization to comply with federal laws related to mental health parity; require behavioral health programs to be accredited and narcotic treatment programs to be licensed in order to be eligible for Medicaid reimbursement; amend KRS 205.522 to require the Department for Medicaid Services and managed care organizations to comply with KRS 304.17A-661 related to treatment of mental health conditions and 304.17A-700 to 304.171A-730 related to payment of claims; require managed care organizations to provide a description of reasons for denial when payment of a claim is denied; amend KRS 304.38-130 to authorize the commissioner of the Department of Insurance to suspend or revoke a Medicaid managed care organization's certificate of authority for willful or frequent and repeated failure to comply with Section 2 of this Act, 42 U.S.C. sec. 1396u-2, or 42 C.F.R. pt. 438 Subpart K; amend KRS 205.533 to require Medicaid managed care organizations to include certain information for providers on their websites; amend KRS 205.534 to require managed care organizations to allow providers 120 days to file an appeal or grievance related to a reduction of denial of a claim; establish penalties for a managed care organization's failure to ensure the timely disposition of any appeal or grievance; require payment of any amount owed to a provider following an appeal to be paid within 30 days; require payments made following an appeal to include 12% interest and reasonable attorney's fees; establish standards and requirements for provider audits; require the inclusion of additional information in the monthly report filed by managed care organizations; require the Department for Medicaid Services to submit an annual report to the Legislative Research Commission related to Medicaid claims, appeals, and grievances; authorize the Department for Medicaid Services to promulgate administrative regulations; require the Cabinet for Health and Family Services or the Department for Medicaid Services to seek federal approval if they determine that such approval is necessary and comply with KRS 205.525.

Summary of Amendment: House Committee Substitute 2

Summary Delete original provisions; create a new section of KRS Chapter 315 to define terms, prohibit discrimination against 340B covered entities by pharmaceutical manufacturers, and authorize the Attorney General to investigate violations; create a new section of KRS Chapter 216 to establish reporting requirements related to the 340B program for covered entities; amend KRS 205.5514 to establish Medicaid reimbursement policies for 340B covered drugs.

Summary of Amendment: House Committee Amendment 1 -- K. Moser

Summary Make title amendment.

Summary of Amendment: House Committee Amendment 2 -- K. Moser

Summary Make title amendment.

Summary of Amendment: House Floor Amendment 1 -- T. Roberts

Summary Create a new section of KRS Chapter 315 to prohibit health facilities from using the 340B drug program to purchase cross sex hormones, puberty blockers, or any medication intended to induce an abortion.

Statutes affected:
House Committee Substitute 1: 205.522, 205.533, 205.534
House Committee Substitute 2: 205.5514