HB1414

Summary

Various health care matters. Requires the budget committee to review certain contracts with managed care organizations for the Medicaid program. Allows a managed care organization and a Medicaid provider to enter into a value based health care reimbursement agreement. Prohibits a managed care organization from imposing on a provider a reimbursement rate or payment methodology through a notice of contract change, a policy, or a provider manual change. Allows for case rate reimbursement for emergency services. Requires a managed care organization to contract with any willing provider if the provider: (1) meets licensure and certification requirements and enrollment criteria; and (2) agrees accept the terms and conditions of the managed care organization to provide services under the risk based managed care program; for Medicaid recipients who are eligible to participate in the Medicare program and receive nursing facility services or home and community based services (program). Requires the office of the secretary of family and social services to establish minimum reimbursement rates for covered services under the program. Requires a health plan to make current prior authorization requirements and restrictions accessible on the health plan's website. Prohibits the implementation of a new or amended prior authorization requirement or restriction unless certain conditions are met. Requires a health plan to release statistics concerning prior authorization and submit a report concerning the statistics to the department of insurance. Provides that a contracting entity may not grant a third party access to the provider network contract or to dental services or contractual discounts provided under the provider network contract unless certain conditions are satisfied. Provides that any provider that is a party to the network contract must be allowed to choose not to participate in the third party access. Prohibits a contracting entity from: (1) altering the rights or status under a provider network contract of a dental provider that chooses not to participate in third party access; or (2) rejecting a provider as a party to a provider network contract because the provider chose not to participate in third party access. Authorizes enforcement by the insurance commissioner. Provides that if a covered individual assigns the covered individual's rights to benefits for dental services to the provider of the dental services, the dental carrier shall pay the benefits assigned by the covered individual to the provider of the dental services. Prohibits the provider from billing the covered individual if the provider is in the dental carrier's network.

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