Medicaid appeals bill heading to governor’s desk

Medicaid appeals bill heading to governor’s desk

Bill Stephens

March 29th, 2016


FRANKFORT – A bill that would give Kentucky’s medical providers a pathway to external, independent appeals of denied Medicaid managed-care claims is on its way to the governor for his signature.

Senate Bill 20, sponsored by Sen. Ralph Alvarado, R-Winchester, would allow medical providers to receive an independent third-party review of claims denied by Medicaid managed care organizations (MCOs). The decision of the third-party reviewer could then be appealed to the Cabinet for Health and Family Services, where the decision of an administrative hearing tribunal would be the last step before judicial review.

The proposed review and appeals process would apply to all contracts or master agreements entered into or renews as of July 1, 2016, according to the bill.

Legislation similar to SB 20 was passed by the 2013 General Assembly and vetoed by former Governor Steve Beshear. Current law requires that appeals be made directly to the MCOs, which serve around 1.1 million Kentuckians.

House Speaker Greg Stumbo, who presented SB 20 for final passage in the House, said it “really gives the providers of medical services an independent evaluation and an independent appeal.”

SB 20, which passed the Senate earlier in the session by a vote of 37-0, cleared the House on a vote of 99-0. It is similar to HB 118, sponsored by Stumbo, which passed the House 92-0 early this session.

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