Bill Text: IA HSB743 | 2023-2024 | 90th General Assembly | Introduced
Bill Title: A bill for an act relating to reimbursement of providers by Medicaid managed care organizations for items or services subject to prior authorization.
Spectrum: Committee Bill
Status: (Introduced - Dead) 2024-04-02 - Subcommittee recommends passage. Vote Total: 3-0. [HSB743 Detail]
Download: Iowa-2023-HSB743-Introduced.html
House
Study
Bill
743
-
Introduced
HOUSE
FILE
_____
BY
(PROPOSED
COMMITTEE
ON
WAYS
AND
MEANS
BILL
BY
CHAIRPERSON
KAUFMANN)
A
BILL
FOR
An
Act
relating
to
reimbursement
of
providers
by
Medicaid
1
managed
care
organizations
for
items
or
services
subject
to
2
prior
authorization.
3
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
4
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_____
Section
1.
NEW
SECTION
.
249A.14
Medicaid
managed
care
1
organizations
——
reimbursement
of
providers
for
items
or
services
2
subject
to
prior
authorization.
3
If
a
provider
obtains
any
necessary
prior
authorization
4
from
a
Medicaid
managed
care
organization
for
an
item
or
5
service
furnished
to
a
recipient,
the
Medicaid
managed
care
6
organization
shall
pay
the
provider
one
hundred
percent
of
the
7
claim
for
reimbursement
for
the
item
or
service,
and
shall
8
not
seek
repayment,
offset
against
future
reimbursement
of
9
claims,
or
other
payment
or
reimbursement
from
the
recipient,
10
the
provider,
or
any
other
source
involved
with
the
furnishing
11
of
the
item
or
service,
unless
the
Medicaid
managed
care
12
organization
determines
the
claim
for
reimbursement
involves
13
fraud
or
misrepresentation.
14
EXPLANATION
15
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
16
the
explanation’s
substance
by
the
members
of
the
general
assembly.
17
This
bill
relates
to
reimbursement
of
a
provider
by
a
18
Medicaid
managed
care
organization
(MCO)
for
an
item
or
service
19
subject
to
prior
authorization.
20
The
bill
provides
that
if
a
provider
obtains
any
necessary
21
prior
authorization
from
an
MCO
for
the
furnishing
of
an
item
22
or
service
to
a
recipient,
the
MCO
shall
pay
the
provider
23
100
percent
of
the
claim
for
reimbursement
for
the
item
or
24
service,
and
shall
not
seek
repayment,
offset
against
future
25
reimbursement
of
claims,
or
other
payment
or
reimbursement
26
from
the
recipient,
the
provider,
or
any
other
source
involved
27
with
the
furnishing
of
the
item
or
service,
unless
the
MCO
28
determines
the
claim
for
reimbursement
involves
fraud
or
29
misrepresentation.
30
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