House Study Bill 743 - Introduced HOUSE FILE _____ BY (PROPOSED COMMITTEE ON WAYS AND MEANS BILL BY CHAIRPERSON KAUFMANN) A BILL FOR An Act relating to reimbursement of providers by Medicaid 1 managed care organizations for items or services subject to 2 prior authorization. 3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 4 TLSB 6375YC (1) 90 pf/ko

H.F. _____ Section 1. NEW SECTION . 249A.14 Medicaid managed care 1 organizations —— reimbursement of providers for items or services 2 subject to prior authorization. 3 If a provider obtains any necessary prior authorization 4 from a Medicaid managed care organization for an item or 5 service furnished to a recipient, the Medicaid managed care 6 organization shall pay the provider one hundred percent of the 7 claim for reimbursement for the item or service, and shall 8 not seek repayment, offset against future reimbursement of 9 claims, or other payment or reimbursement from the recipient, 10 the provider, or any other source involved with the furnishing 11 of the item or service, unless the Medicaid managed care 12 organization determines the claim for reimbursement involves 13 fraud or misrepresentation. 14 EXPLANATION 15 The inclusion of this explanation does not constitute agreement with 16 the explanation’s substance by the members of the general assembly. 17 This bill relates to reimbursement of a provider by a 18 Medicaid managed care organization (MCO) for an item or service 19 subject to prior authorization. 20 The bill provides that if a provider obtains any necessary 21 prior authorization from an MCO for the furnishing of an item 22 or service to a recipient, the MCO shall pay the provider 23 100 percent of the claim for reimbursement for the item or 24 service, and shall not seek repayment, offset against future 25 reimbursement of claims, or other payment or reimbursement 26 from the recipient, the provider, or any other source involved 27 with the furnishing of the item or service, unless the MCO 28 determines the claim for reimbursement involves fraud or 29 misrepresentation. 30 -1- LSB 6375YC (1) 90 pf/ko 1/ 1