SLS 18RS-1837 ENGROSSED
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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1 misinformation by the managed care organization and acted without fault or
2 fraudulent intent. The provider shall prove absence of fault or fraudulent intent
3 by 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 penalties on the managed care
7 organization in accordance with rules and regulations promulgated pursuant
8 to the Administrative Procedure Act.
9 B.(1) Any Medicaid managed care organization that enrolls a provider
10 into 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. Failure
15 to execute the provisions of their responsibility to mitigate fraud and waste shall
16 not be considered a risk of the Medicaid managed care organization. The
17 provisions of this Subsection do not preclude the Medicaid managed care
18 organization from recouping and retaining improper payments and
19 overpayments to a provider after the state has been reimbursed.
20 (2) In addition to the managed care organization being responsible for
21 reimbursement to the state for any payments made to a provider, the Louisiana
22 Department of Health shall impose penalties on the managed care organization
23 in accordance with rules and regulations promulgated pursuant to the
24 Administrative Procedure Act. The managed care organization shall not allege
25 fault or fraudulent intent by a provider unless it can produce written
26 documentation prepared by the provider that includes false information
27 submitted by the provider to the managed care organization.
28 C. Each Medicaid managed care organization shall report every instance
29 of fraud, waste, or abuse to the Louisiana Department of Health and the
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1 attorney general. In addition to the sanction and enforcement authority of the
2 Louisiana Department of Health pursuant to a properly executed contract, the
3 attorney general shall have the authority to investigate, enforce, impose
4 sanctions upon, and seek recoupment from any Medicaid managed care
5 organization pursuant to the provisions of this Section. Recoupments shall be
6 returned to the department. All sanctions, penalties, civil monetary penalties,
7 and additional recoveries or costs of investigations shall be deposited into the
8 Medical Assistance Programs Fraud Detection Fund, as established in R.S.
9 46:440.1.
10 D. Nothing in this Section shall be construed to prevent the Louisiana
11 Department of Health or the attorney general from enforcing and imposing
12 penalties otherwise provided for in law or regulation.
The original instrument and the following digest, which constitutes no part
of the legislative instrument, were prepared by Christine Arbo Peck.
DIGEST
SB 507 Engrossed 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 provides that failure to execute the
provisions of their responsibility to mitigate fraud and waste is not considered a risk of the
Managed care organization.
Proposed law provides that the Medicaid managed care organization is not precluded from
recouping and retaining improper payments and overpayments to a provider after the state
has been reimbursed.
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 penalties
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 requires each Medicaid managed care organization to report every instance of
fraud, waste, or abuse to the Louisiana Department of Health and the attorney general.
Proposed law gives the attorney general authority to investigate, enforce, impose sanctions
upon, and seek recoupment from the Medicaid managed care plans. Proposed law returns
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recoupments to the Louisiana Department of Health and deposits all other monies received
from the Medicaid managed care organizations into the Medical Assistance Programs Fraud
Detection Fund.
Proposed law provides that nothing in proposed law prevents the Louisiana Department of
Health or the attorney general from enforcing and imposing penalties otherwise provided for
in law or regulation.
Effective August 1, 2018.
(Adds R.S. 46:460.72)
Summary of Amendments Adopted by Senate
Committee Amendments Proposed by Senate Committee on Health and Welfare to
the original bill
1. Provides that failure to execute the provisions of the managed care
organization's contractual responsibility to mitigate fraud and waste is not
considered a risk of the managed care organization.
2. Provides that the Medicaid managed care organization is not precluded from
recouping and retaining improper payments and overpayments to a provider
after the state has been reimbursed.
3. Requires each Medicaid managed care organization to report every instance
of fraud, waste, or abuse to the Louisiana Department of Health and the
attorney general.
4. Clarifies that among the attorney general's enforcement authority is the
ability to impose penalties, civil monetary penalties, and additional
recoveries or costs of investigations.
5. Clarifies that the Louisiana Department of Health or the attorney general
shall not be precluded from enforcing and imposing penalties otherwise
provided for in law or regulation.
6. Replaces "monetary sanctions" with "penalties".
7. Removes the word "irrefutably" from the burden of proof provision regarding
false information submitted by the provider to the managed care
organization.
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.