HLS 16RS-3339 REENGROSSED
2016 Regular Session
HOUSE BILL NO. 1157 (Substitute for House Bill No. 761 by Representative Stokes)
BY REPRESENTATIVE STOKES
MEDICAID: Provides relative to the Medicaid provider claims review process
1 AN ACT
2To amend and reenact R.S. 46:442 and to enact R.S. 46:437.4(A)(4), relative to review of
3 healthcare provider claims within the Medicaid program; to provide for
4 reimbursements issued by the Department of Health and Hospitals pursuant to
5 certain provider claims; to provide relative to recoupment of provider claim
6 payments; to authorize re-filing of claims in certain circumstances; and to provide
7 for related matters.
8Be it enacted by the Legislature of Louisiana:
9 Section 1. R.S. 46:442 is hereby amended and reenacted and R.S. 46:437.4(A)(4)
10is hereby enacted to read as follows:
11 §437.4. Claims review and administrative sanctions
12 A.
13 * * *
14 (4) The administrative rules promulgated by the department to implement
15 the claim review process established pursuant to this Subsection shall provide for
16 procedures to ensure that providers receive or retain the appropriate reimbursement
17 amount for claims in which the department determines that services delivered have
18 been improperly billed but were reasonable and necessary.
19 * * *
Page 1 of 3
CODING: Words in struck through type are deletions from existing law; words underscored
are additions. HLS 16RS-3339 REENGROSSED
HB NO. 1157
1 §442. Medicaid provider claims; period for filing
2 A. In administering the Medicaid program of this state, the Department of
3 Health and Hospitals shall not limit the period within which a health care healthcare
4 provider may submit a claim for payment for a covered service rendered to a
5 Medicaid program enrollee to less than three hundred sixty-five days from the date
6 the service was provided.
7 B. In accordance with the applicable provisions of this Part and Part VI-A
8 of this Chapter, if a payment for a claim is recouped by the department, a contractor
9 of the department, or any other entity acting at the direction or under the authority
10 of the department due to a determination by the department more than three hundred
11 sixty-five days from the date the service was provided that the claim was improperly
12 billed but the services were reasonable and necessary, the department shall ensure
13 that the provider is afforded additional time to re-file a corrected claim for that
14 portion of the amount recouped to the extent permitted by federal law.
DIGEST
The digest printed below was prepared by House Legislative Services. It constitutes no part
of the legislative instrument. The keyword, one-liner, abstract, and digest do not constitute
part of the law or proof or indicia of legislative intent. [R.S. 1:13(B) and 24:177(E)]
HB 1157 Reengrossed 2016 Regular Session Stokes
Abstract: Provides relative to the Medicaid provider claims review process.
Present law requires the secretary of the Department of Health and Hospitals, referred to
hereafter as the "department", to establish a process through administrative rulemaking for
review of Medicaid provider claims to determine if the claims should be or should have been
paid as required by federal or state law or regulation.
Proposed law retains present law and stipulates that the administrative rules relative to the
claim review process promulgated pursuant to present law shall provide procedures to ensure
that providers receive or retain the appropriate reimbursement amount for claims in which
the department determines that services delivered have been improperly billed but were
reasonable and necessary.
Present law provides that in administering the Medicaid program, the department shall not
limit the period within which a healthcare provider may submit a claim for payment for a
covered service rendered to a Medicaid enrollee to less than 365 days from the date the
service was provided.
Proposed law retains present law and stipulates that if a payment for a claim is recouped by
the department, a contractor of the department, or any other entity acting at the direction or
under the authority of the department due to a determination more than 365 days from the
Page 2 of 3
CODING: Words in struck through type are deletions from existing law; words underscored
are additions. HLS 16RS-3339 REENGROSSED
HB NO. 1157
date the service was provided that the claim was improperly billed but the services were
reasonable and necessary, the department shall ensure that the provider is afforded additional
time to refile a corrected claim for that portion of the amount recouped to the extent
permitted by federal law.
(Amends R.S. 46:442; Adds R.S. 46:437.4(A)(4))
Summary of Amendments Adopted by House
The House Floor Amendments to the engrossed bill:
1. Clarifies that present law provisions are applicable to proposed law relative to
the recoupment of payments and the refiling of claims.
Page 3 of 3
CODING: Words in struck through type are deletions from existing law; words underscored
are additions.