Behavioral health provider measure passed

Senators approved a bill May 28 that establishes new requirements for behavioral health contract service providers, managed care organizations and Medicaid integrity audits.

LB380, introduced by Sen. John Fredrickson of Omaha, adds requirements for the state Department of Health and Human Services regarding behavioral health contract services and places restrictions on contractors through the state’s managed care organizations.

The bill requires the DHHS Division of Medicaid and Long-Term Care to define network adequacy and contractor compliance with federal and state laws for coverage of mental health and substance use disorders. It also requires:
• public access to all surveys, financial analyses, contract audits and parity reports prepared by a contractor;
• access to mental health and substance use disorder providers through regulation, network adequacy and provider rate adequacy;
• establishment of a monthly electronic communication system with all Medicaid providers and communication of any change in contracts with managed care organizations; and
• annual posting on the DHHS website of criteria that the division uses to assess network adequacy of each MCO.

Under the measure, managed care organizations are:
• prohibited from limiting mental health and substance use disorder coverage more than other conditions;
• required to maintain adequate provider networks for mental health and substance use disorder services;
• required to utilize generally recognized standards of care criteria and make utilization review policies public; and
• prohibited from revoking authorization for mental health and substance use disorder services after a provider renders such service.

The bill includes provisions of LB381, also introduced by Fredrickson, which seek to improve transparency and oversight in Nebraska’s Medicaid auditing system.

Among other provisions, the measure requires program integrity contractors to provide clear justification for an audit and provide an appeals process. It also prohibits recovery of overpayments before all appeals are exhausted except in cases involving a credible allegation of fraud, limits claim reviews to within three years from the date of payment and limits record requests to relevant documents proportional to the services being audited.

Also included are provisions of Lincoln Sen. Eliot Bostar’s LB610, which allow DHHS to seek federal approval for implementation of the Ground Emergency Medical Transport Act.

The department is allowed to distribute the supplemental reimbursement to eligible providers under a payment method based on ground emergency medical transport services provided to Medicaid beneficiaries. The supplemental reimbursement may not exceed the amount of financial participation received as a result of the claims submitted.

Senators voted 48-1 to pass LB380.