MCO bill clears Kentucky House

Friday, February 22, 2019

FRANKFORT, Ky. – A bill that would hold managed care organizations more accountable passed the Kentucky House of Representatives on Thursday 100-0, VGM reports. The bill, H.B. 224, would ensure that DME providers are paid at the rate set by the Kentucky Medicaid program and would ensure that when they receive prior authorizations their claims can’t be denied for “lack of medical necessity.” Stakeholders, including members of KMESA, had been lobbying hard to move the bill in the past couple of weeks. It now moves to the Senate. The bill would also require that specialty items, such as parts to customize wheelchairs, are reimbursed at the manufacturer’s suggested retail price minus 15% or an invoice cost plus 20% when there is no MSRP; require that, should a patient transfer from one MCO to another, services that are currently being provided under a PA will be honored by the new MCO; and require MCOs to cover, at a minimum, the same quantities of supplies covered under the Medicaid fee schedule.