Bill Text: IA SF477 | 2017-2018 | 87th General Assembly | Introduced


Bill Title: A bill for an act relating to Medicaid managed care claims. (Formerly SF 342.)

Spectrum: Committee Bill

Status: (Introduced - Dead) 2017-03-31 - Referred to Human Resources. S.J. 838. [SF477 Detail]

Download: Iowa-2017-SF477-Introduced.html

Senate File 477 - Introduced




                                 SENATE FILE       
                                 BY  COMMITTEE ON HUMAN
                                     RESOURCES

                                 (SUCCESSOR TO SF 342)

                                      A BILL FOR

  1 An Act relating to Medicaid managed care claims.
  2 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
    TLSB 2277SV (3) 87
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PAG LIN



  1  1    Section 1.  MEDICAID MANAGED CARE == UNPAID CLEAN CLAIMS ==
  1  2 INTEREST PENALTY == TIMELY FILING OF CLAIMS.  The department of
  1  3 human services shall adopt rules pursuant to chapter 17A and
  1  4 shall amend Medicaid managed care contracts to require all of
  1  5 the following:
  1  6    1.  That a managed care organization pay an interest penalty
  1  7 of one and one=half percent of the claim amount or unpaid
  1  8 portion of the claim amount to the person submitting the claim
  1  9 for any clean claim not paid within ninety days of timely
  1 10 filing.  The acceptance of an underpayment by the person
  1 11 filing the claim does not constitute payment in full. For the
  1 12 purposes of this section, "clean claim" means a claim for which
  1 13 all information required for submitting the claim is available.
  1 14    2.  That a managed care organization allow Medicaid
  1 15 providers a timely filing period of three hundred sixty=five
  1 16 days from the date of service for submission of claims.  The
  1 17 rules and contract amendments shall also provide that a
  1 18 claim may be resubmitted or adjusted if such action is taken
  1 19 within three hundred sixty=five days from the date of the last
  1 20 adjudication.
  1 21                           EXPLANATION
  1 22 The inclusion of this explanation does not constitute agreement with
  1 23 the explanation's substance by the members of the general assembly.
  1 24    This bill requires the department of human services (DHS)
  1 25 to adopt rules pursuant to Code chapter 17A and amend Medicaid
  1 26 managed care contracts to require all of the following:
  1 27    1. That a managed care organization pay an interest penalty
  1 28 of 1.5 percent of the claim amount or unpaid portion of the
  1 29 claim amount to the person submitting the claim for any clean
  1 30 claim not paid within 90 days of timely filing. The acceptance
  1 31 of an underpayment by the person filing the claim does not
  1 32 constitute payment in full. The bill defines "clean claim" as
  1 33 a claim for which all information required for submitting the
  1 34 claim is available.
  1 35    2. That a managed care organization allow Medicaid
  2  1 providers 365 days from the date of service to submit a claim
  2  2 and also provide that a claim may be resubmitted or adjusted if
  2  3 action is taken within 365 days of the last adjudication.
       LSB 2277SV (3) 87
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