House File 766 H-1170 Amend House File 766 as follows: 1 1. Page 79, after line 35 by inserting: 2 < DIVISION ___ 3 MEDICAID MANAGED CARE —— DISCHARGE PLANNING —— REIMBURSEMENT 4 ASSESSMENTS 5 Sec. ___. MEDICAID MANAGED CARE —— DISCHARGE PLANNING AND 6 PLACEMENT —— REIMBURSEMENT OF SERVICES PROVIDED IN GOOD FAITH 7 —— INTEREST ON LATE PAYMENTS AND OTHER PAYMENTS —— SUPPORTS 8 INTENSITY SCALE ADMINISTRATION. 9 1. The department of human services shall contractually 10 require a Medicaid managed care organization and the Medicaid 11 managed care organization’s case managers, not individual 12 providers of services, to be responsible for the discharge 13 planning and relocation to an appropriate alternative placement 14 of a Medicaid member transitioning from one level of care or 15 placement to another. The Medicaid managed care organization 16 shall have appropriate processes in place to reduce disruption 17 to the Medicaid member during the discharge planning and 18 relocation processes. 19 2. The department of human services shall contractually 20 prohibit a Medicaid managed care organization from denying 21 payment for services rendered by a Medicaid provider who, 22 in good faith, provides services to a Medicaid member in 23 accordance with a service plan and reimbursement agreement. 24 Additionally, under such circumstances, payments shall not 25 be recouped by the department or a Medicaid managed care 26 organization if, subsequent to the provision of such services, 27 the Medicaid managed care organization or the department 28 determines that the member was not eligible for such services 29 and if the provider of services is able to demonstrate, based 30 on the information available to the provider, that the services 31 were authorized at the time the services were rendered. 32 3. The department of human services shall contractually 33 require that a Medicaid managed care organization that fails 34 to pay, deny, or settle a clean claim in full within the time 35 -1- HF766.1574 (1) 88 pf/rn 1/ 2 #1.

frame established by the contract shall pay the Medicaid 1 provider claimant interest equal to twelve percent per annum 2 on the total amount of the claim ultimately authorized. 3 Additionally, if a claim is ultimately found to be incorrectly 4 denied or underpaid through an appeals process or audit, 5 a Medicaid managed care organization shall pay a Medicaid 6 provider claimant, in addition to the amount determined to be 7 owed, interest of twenty percent per annum on the total amount 8 of the claim ultimately authorized as calculated from fifteen 9 calendar days after the date the claim was submitted. 10 4. The department of human services shall contract with 11 an independent third party to administer a conflict-free 12 uniform supports intensity scale assessment for persons with 13 an intellectual disability or developmental disability. The 14 assessment tool shall include an evaluation of the functional 15 skills and abilities of the Medicaid member at the following 16 three levels: without the provision of any supports and 17 services, with the provision of the current level of supports 18 and services, and with the provision of additional supports 19 and services to assist the member in reaching the member’s 20 full potential. The assessment tool shall include a narrative 21 portion to more fully reflect and identify the unique supports 22 and service needs and concerns of the member as well as the 23 member’s family and caregivers. > 24 2. By renumbering as necessary. 25 ______________________________ HEDDENS of Story -2- HF766.1574 (1) 88 pf/rn 2/ 2 #2.