Relating to Medicaid managed care including the provision of certain services and payment for services

The MCO shall have appropriate processes in place to reduce disruption to the Medicaid member during the discharge planning and relocation processes. The bill requires DHS to also contractually prohibit an MCO from denying payment for services rendered by a Medicaid provider who, in good faith, provides services to a Medicaid member in accordance with a service plan and reimbursement agreement. The bill also prohibits recoupment of payments if, subsequent to the provision of such services, the MCO or DHS determines that the member was not eligible for such services and if the provider of services is able to demonstrate, based on the information available to the provider, that the services were authorized at the time the services were rendered. The bill requires DHS to contractually require that an MCO that fails to pay, deny, or settle a clean claim in full within the time frame established by the contract to pay the Medicaid provider claimant interest equal to percent per annum on the total amount of the claim ultimately authorized. Additionally, if a claim is ultimately found to be incorrectly denied or underpaid through an appeals process or audit, an MCO shall pay a Medicaid provider claimant, in addition to the amount determined to be owed, interest of percent per annum on the total amount of the claim ultimately authorized as calculated from calendar days after the date the claim was submitted. The bill requires DHS to contract with an independent third party to administer a conflict-free uniform supports intensity scale assessment for persons with an intellectual disability or developmental disability. The assessment tool shall include an evaluation of the functional skills and abilities of the Medicaid member at three levels: without the provision of any supports and services, with the provision of the current level of supports and services, and with the provision of additional supports and services to assist the member in reaching the member’s full potential. The assessment tool shall include a narrative portion to more fully reflect and identify the unique supports and service needs and concerns of the member as well as the member’s family and caregivers.