Managed care changes adopted

A bill that changes provider notification procedures for state-contracted managed care companies that deliver Medicaid services passed Aug. 4.

<a href='http://news.legislature.ne.gov/dist15' target='_blank' title='Link to the website of Sen. Lynne Walz'>Sen. Lynne Walz</a>
Sen. Lynne Walz

LB956, introduced by Fremont Sen. Lynne Walz, requires notice of material changes to an agreement between health care providers and a managed care organization. Under the bill, providers will receive:
• 60-day notice of any material change;
• a proposed effective date of the change;
• a description of 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 reasonably may be expected to significantly increase the provider’s administrative expense, including altering an existing prior authorization, precertification, notification or referral program or specific edits.

The bill also clarifies the intent of Medicaid program integrity audits and requires the state Department of Health and Human Services to notify Medicaid recipients when eligibility is discontinued or modified.

LB956 passed on a 47-0 vote.

Bookmark and Share
Share