Health and Human Services

Managed care changes advanced

A bill that would change provider notification procedures for state-contracted managed care companies that deliver Medicaid services advanced from general file July 22.

Sen. Lynne Walz
Sen. Lynne Walz

LB956, introduced by Fremont Sen. Lynne Walz, would require notice of material changes to an agreement between health care providers and a managed care organization. Under the bill, providers would receive:
• 90-day notice of any material change;
• a proposed effective date of the change;
• a description of the change;
• notice that the provider can accept or reject the change;
• contact information for the managed care organization;
• the opportunity to meet with the managed care organization; and
• a copy of the entire agreement after three material changes in 12 months.

LB956 defines a material change as one that decreases a provider’s payment or compensation, or changes the administrative procedures in a way that may reasonably be expected to significantly increase the provider’s administrative expense, including altering an existing prior authorization, precertification, notification or referral program or specific edits.

Walz said providers in Nebraska have suddenly, and without warning, stopped being paid for services, which can lead to care delays for patients.

“The current notification process is not nearly substantial enough,” Walz said. “This has caused a number of issues.”

A Health and Human Services Committee amendment, adopted 42-0, added provisions of Walz’ LB955 and LB1105, introduced by Blair Sen. Ben Hansen.

The provisions would require the state Department of Health and Human Services to notify Medicaid recipients when eligibility is discontinued or modified and clarify the intent of Medicaid program integrity audits.

Lawmakers advanced the amended bill to select file on a 45-0 vote.

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