HF 808 (LSB 1970YH (3) 91)

HOUSE FILE 808

BY  RINKER

A BILL FOR

An Act relating to managed care organization chargebacks and third-party auditors.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  NEW SECTION.  249A.14  Managed care organizations —— chargebacks.
   1.  A managed care organization acting pursuant to a contract with the department to administer the medical assistance program under this chapter shall not issue a chargeback to a provider more than twelve months from the date the managed care organization provided reimbursement to the provider.
   2.  A managed care organization acting pursuant to a contract with the department to administer the medical assistance program under this chapter shall negotiate a fee with a third-party auditor prior to the third-party auditor initiating an audit of a provider on behalf of the managed care organization. A managed care organization shall not base the managed care organization’s compensation to a third-party auditor on the percentage of chargebacks identified by the third-party auditor.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
   This bill requires a managed care organization (MCO) acting pursuant to a contract with the department of health and human services to administer the medical assistance program to issue a chargeback to a provider within 12 months from the date the MCO provided reimbursement to the provider.
   The bill requires an MCO to negotiate a fee with a third-party auditor (auditor) prior to the auditor initiating an audit of a provider. An MCO shall not base compensation for an auditor on the percentage of chargebacks identified by the auditor.