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Indiana House Bill HB1372

Indiana 2023 Regular Session

Indiana House Bill HB1372 Compare Versions

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1-*HB1372.1*
2-January 24, 2023
1+
2+Introduced Version
33 HOUSE BILL No. 1372
44 _____
5-DIGEST OF HB 1372 (Updated January 24, 2023 11:22 am - DI 147)
6-Citations Affected: IC 12-15.
7-Synopsis: Credentialing for Medicaid services. Requires the office of
8-Medicaid policy and planning (office) to prescribe a credentialing
9-application form to be used by: (1) a provider who applies for
10-credentialing by a managed care organization or a contractor of the
11-office (contractor); and (2) a managed care organization or contractor
12-that performs credentialing activities. Requires a managed care
13-organization or contractor to notify a provider concerning: (1) any
14-deficiency in the provider's unclean credentialing application; and (2)
15-the status of the provider's clean credentialing application. Provides
16-that if the managed care organization or contractor fails to issue a
17-credentialing determination within 30 days after receiving a provider's
18-completed credentialing application, the managed care organization or
19-contractor shall provisionally credential the provider if the provider
20-meets certain criteria. Provides that if the managed care organization
21-or contractor fully credentials a provider, then reimbursement payments
22-to the provider shall be paid retroactive to the date on which the initial
23-credentialing application was received and the provider shall be
24-reimbursed at the rates determined by the contract between the
25-provider and the managed care organization or contractor.
5+DIGEST OF INTRODUCED BILL
6+Citations Affected: IC 12-15-11-10.
7+Synopsis: Medicaid services provided pending credentialing. Provides
8+that after a provider who is an individual: (1) is enrolled in the
9+Medicaid program; (2) files a provider agreement with the office of
10+Medicaid policy and planning (office); (3) applies for credentialing;
11+and (4) applies to participate in the network of a managed care
12+organization or contractor of the office; the individual may begin
13+providing services to individuals eligible for Medicaid services and
14+may bill for the services provided. Requires the managed care
15+organization or contractor of the office to compensate the provider for
16+the services provided if the provider's application for credentialing is
17+approved and the provider qualifies to participate in the network.
18+Provides that, if the provider is denied credentialing, the managed care
19+organization or contractor of the office is not required to compensate
20+the provider for the services provided.
2621 Effective: July 1, 2023.
27-King, Barrett, Schaibley
22+King, Barrett
2823 January 17, 2023, read first time and referred to Committee on Public Health.
29-January 24, 2023, amended, reported — Do Pass.
30-HB 1372—LS 7370/DI 55 January 24, 2023
24+2023 IN 1372—LS 7370/DI 55 Introduced
3125 First Regular Session of the 123rd General Assembly (2023)
3226 PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana
3327 Constitution) is being amended, the text of the existing provision will appear in this style type,
3428 additions will appear in this style type, and deletions will appear in this style type.
3529 Additions: Whenever a new statutory provision is being enacted (or a new constitutional
3630 provision adopted), the text of the new provision will appear in this style type. Also, the
3731 word NEW will appear in that style type in the introductory clause of each SECTION that adds
3832 a new provision to the Indiana Code or the Indiana Constitution.
3933 Conflict reconciliation: Text in a statute in this style type or this style type reconciles conflicts
4034 between statutes enacted by the 2022 Regular Session of the General Assembly.
4135 HOUSE BILL No. 1372
4236 A BILL FOR AN ACT to amend the Indiana Code concerning
4337 human services.
4438 Be it enacted by the General Assembly of the State of Indiana:
4539 1 SECTION 1. IC 12-15-11-10 IS ADDED TO THE INDIANA
4640 2 CODE AS A NEW SECTION TO READ AS FOLLOWS
47-3 [EFFECTIVE JULY 1, 2023]: Sec. 10. (a) As used in this section,
48-4 "clean credentialing application" means an application for
49-5 network participation that:
50-6 (1) is submitted by a provider under this section;
51-7 (2) does not contain an error; and
52-8 (3) may be processed by the managed care organization or
53-9 contractor of the office without returning the application to
54-10 the provider for a revision or clarification.
55-11 (b) As used in this section, "credentialing" means a process by
56-12 which a managed care organization or contractor of the office
57-13 makes a determination that:
58-14 (1) is based on criteria established by the managed care
59-15 organization or contractor of the office; and
60-16 (2) concerns whether a provider is eligible to:
61-17 (A) provide health services to an individual eligible for
62-HB 1372—LS 7370/DI 55 2
63-1 Medicaid services; and
64-2 (B) receive reimbursement for the health services;
65-3 under an agreement that is entered into between the provider
66-4 and managed care organization or contractor of the office.
67-5 (c) As used in this section, "unclean credentialing application"
68-6 means an application for network participation that:
69-7 (1) is submitted by a provider under this section;
70-8 (2) contains at least one (1) error; and
71-9 (3) must be returned to the provider to correct the error.
72-10 (d) This section applies to a managed care organization or a
73-11 contractor of the office.
74-12 (e) The office shall prescribe the credentialing application form
75-13 used by the Council for Affordable Quality Healthcare in
76-14 electronic or paper format, which must be used by:
77-15 (1) a provider who applies for credentialing by a managed
78-16 care organization or a contractor of the office; and
79-17 (2) a managed care organization or a contractor of the office
80-18 that performs credentialing activities.
81-19 (f) A managed care organization or contractor of the office shall
82-20 notify a provider concerning a deficiency on a completed unclean
83-21 credentialing application form submitted by the provider not later
84-22 than thirty (30) business days after the entity receives the
85-23 completed unclean credentialing application form. A notice
86-24 described in this subsection must:
87-25 (1) provide a description of the deficiency; and
88-26 (2) state the reason why the application was determined to be
89-27 an unclean credentialing application.
90-28 (g) A managed care organization or contractor of the office shall
91-29 notify a provider concerning the status of the provider's completed
92-30 clean credentialing application not later than:
93-31 (1) sixty (60) days after the entity receives the completed clean
94-32 credentialing application form; and
95-33 (2) every thirty (30) days after the notice is provided under
96-34 subdivision (1), until the entity makes a final credentialing
97-35 determination concerning the provider.
98-36 (h) Notwithstanding subsection (g), if the managed care
99-37 organization or contractor of the office fails to issue a credentialing
100-38 determination within thirty (30) days after receiving a completed
101-39 credentialing application form from a provider, the managed care
102-40 organization or contractor of the office shall provisionally
103-41 credential the provider if the provider meets the following criteria:
104-42 (1) The provider has submitted a completed and signed clean
105-HB 1372—LS 7370/DI 55 3
106-1 credentialing application form and any required supporting
107-2 material to the managed care organization or contractor of
108-3 the office.
109-4 (2) The provider was previously credentialed by the managed
110-5 care organization or contractor of the office in Indiana and in
111-6 the same scope of practice for which the provider has applied
112-7 for provisional credentialing or the provider is a member of
113-8 a provider group or health facility that is credentialed and a
114-9 participating provider with the managed care organization or
115-10 the contractor of the office.
116-11 (i) The criteria for issuing provisional credentialing under
117-12 subsection (h) may not be less stringent than the standards and
118-13 guidelines governing provisional credentialing from the National
119-14 Committee for Quality Assurance or its successor organization.
120-15 (j) Once a managed care organization or the contractor of the
121-16 office fully credentials a provider that holds provisional
122-17 credentialing and a network provider agreement has been
123-18 executed, then reimbursement payments under the contract shall
124-19 be paid retroactive to the date the initial credentialing application
125-20 was received. The managed care organization or contractor of the
126-21 office shall reimburse the provider at the rates determined by the
127-22 contract between the provider and the:
128-23 (1) managed care organization; or
129-24 (2) contractor of the office.
130-25 (k) If a managed care organization or contractor of the office
131-26 does not fully credential a provider that is provisionally
132-27 credentialed under subsection (h), the provisional credentialing is
133-28 terminated on the date the managed care organization or
134-29 contractor of the office notifies the provider of the adverse
135-30 credentialing determination. The managed care organization or
136-31 contractor of the office is not required to reimburse for services
137-32 rendered while the provider was provisionally credentialed.
138-HB 1372—LS 7370/DI 55 4
139-COMMITTEE REPORT
140-Mr. Speaker: Your Committee on Public Health, to which was
141-referred House Bill 1372, has had the same under consideration and
142-begs leave to report the same back to the House with the
143-recommendation that said bill be amended as follows:
144-Page 1, line 3, delete "After a provider who is an" and insert "As
145-used in this section, "clean credentialing application" means an
146-application for network participation that:
147-(1) is submitted by a provider under this section;
148-(2) does not contain an error; and
149-(3) may be processed by the managed care organization or
150-contractor of the office without returning the application to
151-the provider for a revision or clarification.
152-(b) As used in this section, "credentialing" means a process by
153-which a managed care organization or contractor of the office
154-makes a determination that:
155-(1) is based on criteria established by the managed care
156-organization or contractor of the office; and
157-(2) concerns whether a provider is eligible to:
158-(A) provide health services to an individual eligible for
159-Medicaid services; and
160-(B) receive reimbursement for the health services;
161-under an agreement that is entered into between the provider
162-and managed care organization or contractor of the office.
163-(c) As used in this section, "unclean credentialing application"
164-means an application for network participation that:
165-(1) is submitted by a provider under this section;
166-(2) contains at least one (1) error; and
167-(3) must be returned to the provider to correct the error.
168-(d) This section applies to a managed care organization or a
169-contractor of the office.
170-(e) The office shall prescribe the credentialing application form
171-used by the Council for Affordable Quality Healthcare in
172-electronic or paper format, which must be used by:
173-(1) a provider who applies for credentialing by a managed
174-care organization or a contractor of the office; and
175-(2) a managed care organization or a contractor of the office
176-that performs credentialing activities.
177-(f) A managed care organization or contractor of the office shall
178-notify a provider concerning a deficiency on a completed unclean
179-credentialing application form submitted by the provider not later
180-than thirty (30) business days after the entity receives the
181-HB 1372—LS 7370/DI 55 5
182-completed unclean credentialing application form. A notice
183-described in this subsection must:
184-(1) provide a description of the deficiency; and
185-(2) state the reason why the application was determined to be
186-an unclean credentialing application.
187-(g) A managed care organization or contractor of the office shall
188-notify a provider concerning the status of the provider's completed
189-clean credentialing application not later than:
190-(1) sixty (60) days after the entity receives the completed clean
191-credentialing application form; and
192-(2) every thirty (30) days after the notice is provided under
193-subdivision (1), until the entity makes a final credentialing
194-determination concerning the provider.
195-(h) Notwithstanding subsection (g), if the managed care
196-organization or contractor of the office fails to issue a credentialing
197-determination within thirty (30) days after receiving a completed
198-credentialing application form from a provider, the managed care
199-organization or contractor of the office shall provisionally
200-credential the provider if the provider meets the following criteria:
201-(1) The provider has submitted a completed and signed clean
202-credentialing application form and any required supporting
203-material to the managed care organization or contractor of
204-the office.
205-(2) The provider was previously credentialed by the managed
206-care organization or contractor of the office in Indiana and in
207-the same scope of practice for which the provider has applied
208-for provisional credentialing or the provider is a member of
209-a provider group or health facility that is credentialed and a
210-participating provider with the managed care organization or
211-the contractor of the office.
212-(i) The criteria for issuing provisional credentialing under
213-subsection (h) may not be less stringent than the standards and
214-guidelines governing provisional credentialing from the National
215-Committee for Quality Assurance or its successor organization.
216-(j) Once a managed care organization or the contractor of the
217-office fully credentials a provider that holds provisional
218-credentialing and a network provider agreement has been
219-executed, then reimbursement payments under the contract shall
220-be paid retroactive to the date the initial credentialing application
221-was received. The managed care organization or contractor of the
222-office shall reimburse the provider at the rates determined by the
223-contract between the provider and the:
224-HB 1372—LS 7370/DI 55 6
225-(1) managed care organization; or
226-(2) contractor of the office.
227-(k) If a managed care organization or contractor of the office
228-does not fully credential a provider that is provisionally
229-credentialed under subsection (h), the provisional credentialing is
230-terminated on the date the managed care organization or
231-contractor of the office notifies the provider of the adverse
232-credentialing determination. The managed care organization or
233-contractor of the office is not required to reimburse for services
234-rendered while the provider was provisionally credentialed.".
235-Page 1, delete lines 4 through 17.
236-Delete page 2.
237-and when so amended that said bill do pass.
238-(Reference is to HB 1372 as introduced.)
239-BARRETT
240-Committee Vote: yeas 13, nays 0.
241-HB 1372—LS 7370/DI 55
41+3 [EFFECTIVE JULY 1, 2023]: Sec. 10. (a) After a provider who is an
42+4 individual:
43+5 (1) is enrolled in the Medicaid program according to the rules
44+6 adopted by the secretary;
45+7 (2) files a provider agreement with the office under section 2
46+8 of this chapter;
47+9 (3) applies for credentialing; and
48+10 (4) qualifies to participate in the network of a managed care
49+11 organization or contractor of the office;
50+12 the individual may begin providing services to individuals eligible
51+13 for Medicaid services and may bill for the services.
52+14 (b) If a provider described in subsection (a):
53+15 (1) is granted credentialing; and
54+16 (2) qualifies to participate in the network of the managed care
55+17 organization or contractor of the office referred to in
56+2023 IN 1372—LS 7370/DI 55 2
57+1 subsection (a)(4);
58+2 the managed care organization or contractor of the office shall
59+3 compensate the provider for all services that the provider provided
60+4 to individuals eligible for Medicaid services beginning on the date
61+5 on which the provider was authorized to begin providing services
62+6 under subsection (a).
63+7 (c) If a provider described in subsection (a) is denied
64+8 credentialing, the managed care organization or contractor of the
65+9 office referred to in subsection (a)(4) is not required to compensate
66+10 the provider for services that the provider provided to individuals
67+11 eligible for Medicaid services during the period beginning on the
68+12 date on which the provider was authorized to begin providing
69+13 services under subsection (a).
70+2023 IN 1372—LS 7370/DI 55