Senate File 477 - Introduced SENATE FILE 477 BY COMMITTEE ON HUMAN RESOURCES (SUCCESSOR TO SF 342) A BILL FOR An Act relating to Medicaid managed care claims. 1 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 2 TLSB 2277SV (3) 87 pf/nh

S.F. 477 Section 1. MEDICAID MANAGED CARE —— UNPAID CLEAN CLAIMS —— 1 INTEREST PENALTY —— TIMELY FILING OF CLAIMS. The department of 2 human services shall adopt rules pursuant to chapter 17A and 3 shall amend Medicaid managed care contracts to require all of 4 the following: 5 1. That a managed care organization pay an interest penalty 6 of one and one-half percent of the claim amount or unpaid 7 portion of the claim amount to the person submitting the claim 8 for any clean claim not paid within ninety days of timely 9 filing. The acceptance of an underpayment by the person 10 filing the claim does not constitute payment in full. For the 11 purposes of this section, “clean claim” means a claim for which 12 all information required for submitting the claim is available. 13 2. That a managed care organization allow Medicaid 14 providers a timely filing period of three hundred sixty-five 15 days from the date of service for submission of claims. The 16 rules and contract amendments shall also provide that a 17 claim may be resubmitted or adjusted if such action is taken 18 within three hundred sixty-five days from the date of the last 19 adjudication. 20 EXPLANATION 21 The inclusion of this explanation does not constitute agreement with 22 the explanation’s substance by the members of the general assembly. 23 This bill requires the department of human services (DHS) 24 to adopt rules pursuant to Code chapter 17A and amend Medicaid 25 managed care contracts to require all of the following: 26 1. That a managed care organization pay an interest penalty 27 of 1.5 percent of the claim amount or unpaid portion of the 28 claim amount to the person submitting the claim for any clean 29 claim not paid within 90 days of timely filing. The acceptance 30 of an underpayment by the person filing the claim does not 31 constitute payment in full. The bill defines “clean claim” as 32 a claim for which all information required for submitting the 33 claim is available. 34 2. That a managed care organization allow Medicaid 35 -1- LSB 2277SV (3) 87 pf/nh 1/ 2

S.F. 477 providers 365 days from the date of service to submit a claim 1 and also provide that a claim may be resubmitted or adjusted if 2 action is taken within 365 days of the last adjudication. 3 -2- LSB 2277SV (3) 87 pf/nh 2/ 2