Medicaid providers and managed care organizations.
Summary
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 administrative appeal within the office of Medicaid policy and planning of the managed care organization's action in denying or reducing reimbursement for claims for covered services provided to an applicant, pending applicant, conditionally eligible individual, or member. Establishes a procedure for an administrative appeal, including a hearing before an administrative law judge that could be followed by agency review and then by judicial review. 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 administrative appeal and provides that such a contract provision is void and unenforceable. Repeals a provision under which Medicaid law is controlling when Medicaid law conflicts with insurance law. Provides that if the office of the secretary of family and social services 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 time filing requirements for the claim.
Bill status
in committee
1 of 4 stages cleared
Introduction
Jan 2021
Committee Review
Floor Vote
Governor
Introduced Jan 14, 2021
Last action Jan 14, 2021
Floor votes
How they voted
No floor votes recorded yet.
Full legislative history
Actions timeline
Total actions
3
Key actions
0
Committee
0
1 primary · 3 co-sponsors
Sponsors
Role
Legislator
Party
State
District
P
Ed Clere
IIndependent
Co
Ann Vermilion
RRepublican
Co
Jeff Thompson
RRepublican
Co
RF
Rita Fleming
DDemocratic
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