SLS 18RS-1837 ORIGINAL
2018 Regular Session
SENATE BILL NO. 507
BY SENATOR MILLS
MEDICAID. Provides relative to Medicaid managed care organizations. (8/1/18)
1 AN ACT
2 To enact R.S. 46:460.72, relative to Medicaid managed care organizations; to provide for
3 plan payment accountability; to provide for payment to providers; to provide for
4 obligations by the managed care organizations; to provide for reimbursement to the
5 state; to provide for authority of the attorney general; to provide for deposits into the
6 Medical Assistance Programs Fraud Detection Fund; and to provide for related
7 matters.
8 Be it enacted by the Legislature of Louisiana:
9 Section 1. R.S. 46:460.72 is hereby enacted to read as follows:
10 ยง460.72. Medicaid managed care plan payment accountability
11 A. Any Medicaid managed care organization that enrolls a provider into
12 its provider network and fails to ensure proper compliance with Medicaid
13 provider enrollment, credentialing, or accreditation requirements shall be liable
14 for reimbursement to the provider for any services rendered to Medicaid
15 recipients during the period in question, to be paid from the administrative
16 funds of the managed care organization, until such time as the deficiency in the
17 providers status is remedied if the provider relied in good faith on
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions. SB NO. 507
SLS 18RS-1837 ORIGINAL
1 misinformation by the managed care plan and acted without fault or fraudulent
2 intent. The provider shall prove absence of fault or fraudulent intent by
3 producing guidance, applications, or other written communication from the
4 managed care organization that bears incorrect information. In addition to the
5 managed care organization being responsible for payment to the provider, the
6 Louisiana Department of Health shall impose monetary sanctions on the
7 managed care organization in accordance with rules and regulations
8 promulgated pursuant to the Administrative Procedure Act.
9 B. Any Medicaid managed care organization that enrolls a provider into
10 the provider network and fails to ensure proper compliance with Medicaid
11 provider enrollment, credentialing, or accreditation requirements shall be liable
12 for reimbursement to the state for any claims paid to the provider during the
13 period in question, to be paid from the administrative funds of the managed
14 care organization, if the provider acted with fault or fraudulent intent. In
15 addition to the managed care organization being responsible for reimbursement
16 to the state for any payments made to a provider, the Louisiana Department of
17 Health shall impose monetary sanctions on the managed care organization in
18 accordance with rules and regulations promulgated pursuant to the
19 Administrative Procedure Act. The managed care organization shall not allege
20 fault or fraudulent intent by a provider unless it can produce written
21 documentation prepared by the provider that includes irrefutably false
22 information submitted by the provider to the managed care organization.
23 C. The attorney general shall have the authority to investigate, enforce,
24 and seek recoupment from any Medicaid managed care organization pursuant
25 to the provisions of this Section. Any funds collected by the Louisiana
26 Department of Health as a result of sanctions imposed upon the Medicaid
27 managed care plans or funds recouped by the attorney general, or both, shall
28 be deposited into the Medical Assistance Programs Fraud Detection Fund, as
29 established in R.S. 46:440.1.
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions. SB NO. 507
SLS 18RS-1837 ORIGINAL
The original instrument and the following digest, which constitutes no part
of the legislative instrument, were prepared by Christine Arbo Peck.
DIGEST
SB 507 Original 2018 Regular Session Mills
Proposed law provides that a Medicaid managed care organization shall be liable to a
provider for payment of claims to the provider when the provider followed instructions of
the managed care organization to his detriment and did not act with fault or fraudulent intent
regarding enrollment, credentialing, or accreditation.
Proposed law provides that a Medicaid managed care organization shall be liable to the state
for any payment to providers when the provider acts with fault or fraudulent intent regarding
enrollment, credentialing, or accreditation.
Proposed law requires the managed care organization to cover the expense of reimbursement
to the provider or to the state from the administrative funding allocated to the managed care
organization. Proposed law requires the Louisiana Department of Health to impose monetary
sanctions on the Medicaid managed care plan for the infractions established in proposed law
in accordance with rules and regulations promulgated pursuant to the Administrative
Procedure Act.
Proposed law gives the attorney general authority to investigate, enforce, and seek
recoupment from the Medicaid managed care plans. Proposed law deposits monies received
from the Medicaid managed care plans into the Medical Assistance Programs Fraud
Detection Fund.
Effective August 1, 2018.
(Adds R.S. 46:460.72)
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.