Bill Text: IA HF555 | 2019-2020 | 88th General Assembly | Introduced

Iowa House Bill 555 (Prior Session Legislation)

Introduced

Bill Title: A bill for an act relating to Medicaid managed care including the provision of certain services and payment for services.

Spectrum: Partisan Bill (Democrat 8-0)

Status: (Introduced - Dead) 2019-02-28 - Introduced, referred to Human Resources. H.J. 374. [HF555 Detail]

Download: Iowa-2019-HF555-Introduced.html

House File 555 - Introduced HOUSE FILE 555 BY HEDDENS , STAED , FORBES , HUNTER , GASKILL , KRESSIG , JACOBY , and WINCKLER A BILL FOR An Act relating to Medicaid managed care including the 1 provision of certain services and payment for services. 2 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 3 TLSB 2125YH (4) 88 pf/rh

H.F. 555 Section 1. MEDICAID MANAGED CARE —— DISCHARGE PLANNING AND 1 PLACEMENT —— REIMBURSEMENT OF SERVICES PROVIDED IN GOOD FAITH 2 —— INTEREST ON LATE PAYMENTS AND OTHER PAYMENTS —— SUPPORTS 3 INTENSITY SCALE ADMINISTRATION. 4 1. The department of human services shall contractually 5 require a Medicaid managed care organization and the Medicaid 6 managed care organization’s case managers, not individual 7 providers of services, to be responsible for the discharge 8 planning and relocation to an appropriate alternative placement 9 of a Medicaid member transitioning from one level of care or 10 placement to another. The Medicaid managed care organization 11 shall have appropriate processes in place to reduce disruption 12 to the Medicaid member during the discharge planning and 13 relocation processes. 14 2. The department of human services shall contractually 15 prohibit a Medicaid managed care organization from denying 16 payment for services rendered by a Medicaid provider who, 17 in good faith, provides services to a Medicaid member in 18 accordance with a service plan and reimbursement agreement. 19 Additionally, under such circumstances, payments shall not 20 be recouped by the department or a Medicaid managed care 21 organization if, subsequent to the provision of such services, 22 the Medicaid managed care organization or the department 23 determines that the member was not eligible for such services 24 and if the provider of services is able to demonstrate, based 25 on the information available to the provider, that the services 26 were authorized at the time the services were rendered. 27 3. The department of human services shall contractually 28 require that a Medicaid managed care organization that fails 29 to pay, deny, or settle a clean claim in full within the time 30 frame established by the contract shall pay the Medicaid 31 provider claimant interest equal to twelve percent per annum 32 on the total amount of the claim ultimately authorized. 33 Additionally, if a claim is ultimately found to be incorrectly 34 denied or underpaid through an appeals process or audit, 35 -1- LSB 2125YH (4) 88 pf/rh 1/ 3

H.F. 555 a Medicaid managed care organization shall pay a Medicaid 1 provider claimant, in addition to the amount determined to be 2 owed, interest of twenty percent per annum on the total amount 3 of the claim ultimately authorized as calculated from fifteen 4 calendar days after the date the claim was submitted. 5 4. The department of human services shall contract with 6 an independent third party to administer a conflict-free 7 uniform supports intensity scale assessment for persons with 8 an intellectual disability or developmental disability. The 9 assessment tool shall include an evaluation of the functional 10 skills and abilities of the Medicaid member at the following 11 three levels: without the provision of any supports and 12 services, with the provision of the current level of supports 13 and services, and with the provision of additional supports 14 and services to assist the member in reaching the member’s 15 full potential. The assessment tool shall include a narrative 16 portion to more fully reflect and identify the unique supports 17 and service needs and concerns of the member as well as the 18 member’s family and caregivers. 19 EXPLANATION 20 The inclusion of this explanation does not constitute agreement with 21 the explanation’s substance by the members of the general assembly. 22 This bill includes provisions relating to Medicaid 23 managed care including discharge planning and relocation 24 responsibilities, reimbursement of services provided in good 25 faith, interest on late and other payments, and supports 26 intensity scale assessment administration. 27 The bill requires the department of human services (DHS) 28 to contractually require a Medicaid managed care organization 29 (MCO) and the MCO’s case managers, not individual providers 30 of services, to be responsible for the discharge planning 31 and relocation to an appropriate alternative placement of 32 a Medicaid member transitioning from one level of care or 33 placement to another. The MCO shall have appropriate processes 34 in place to reduce disruption to the Medicaid member during the 35 -2- LSB 2125YH (4) 88 pf/rh 2/ 3

H.F. 555 discharge planning and relocation processes. 1 The bill requires DHS to also contractually prohibit an 2 MCO from denying payment for services rendered by a Medicaid 3 provider who, in good faith, provides services to a Medicaid 4 member in accordance with a service plan and reimbursement 5 agreement. The bill also prohibits recoupment of payments if, 6 subsequent to the provision of such services, the MCO or DHS 7 determines that the member was not eligible for such services 8 and if the provider of services is able to demonstrate, based 9 on the information available to the provider, that the services 10 were authorized at the time the services were rendered. 11 The bill requires DHS to contractually require that an MCO 12 that fails to pay, deny, or settle a clean claim in full within 13 the time frame established by the contract to pay the Medicaid 14 provider claimant interest equal to 12 percent per annum on the 15 total amount of the claim ultimately authorized. Additionally, 16 if a claim is ultimately found to be incorrectly denied or 17 underpaid through an appeals process or audit, an MCO shall 18 pay a Medicaid provider claimant, in addition to the amount 19 determined to be owed, interest of 20 percent per annum on the 20 total amount of the claim ultimately authorized as calculated 21 from 15 calendar days after the date the claim was submitted. 22 The bill requires DHS to contract with an independent third 23 party to administer a conflict-free uniform supports intensity 24 scale assessment for persons with an intellectual disability or 25 developmental disability. The assessment tool shall include 26 an evaluation of the functional skills and abilities of the 27 Medicaid member at three levels: without the provision of any 28 supports and services, with the provision of the current level 29 of supports and services, and with the provision of additional 30 supports and services to assist the member in reaching the 31 member’s full potential. The assessment tool shall include a 32 narrative portion to more fully reflect and identify the unique 33 supports and service needs and concerns of the member as well 34 as the member’s family and caregivers. 35 -3- LSB 2125YH (4) 88 pf/rh 3/ 3