H.F. 808 Section 1. NEW SECTION . 249A.14 Managed care organizations 1 —— chargebacks. 2 1. A managed care organization acting pursuant to a contract 3 with the department to administer the medical assistance 4 program under this chapter shall not issue a chargeback to a 5 provider more than twelve months from the date the managed care 6 organization provided reimbursement to the provider. 7 2. A managed care organization acting pursuant to a 8 contract with the department to administer the medical 9 assistance program under this chapter shall negotiate a fee 10 with a third-party auditor prior to the third-party auditor 11 initiating an audit of a provider on behalf of the managed 12 care organization. A managed care organization shall not base 13 the managed care organization’s compensation to a third-party 14 auditor on the percentage of chargebacks identified by the 15 third-party auditor. 16 EXPLANATION 17 The inclusion of this explanation does not constitute agreement with 18 the explanation’s substance by the members of the general assembly. 19 This bill requires a managed care organization (MCO) acting 20 pursuant to a contract with the department of health and human 21 services to administer the medical assistance program to issue 22 a chargeback to a provider within 12 months from the date the 23 MCO provided reimbursement to the provider. 24 The bill requires an MCO to negotiate a fee with a 25 third-party auditor (auditor) prior to the auditor initiating 26 an audit of a provider. An MCO shall not base compensation for 27 an auditor on the percentage of chargebacks identified by the 28 auditor. 29 -1- LSB 1970YH (3) 91 lh/ko 1/ 1