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 Engrossed 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 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 re-file 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))