HLS 20RS-339 ORIGINAL
2020 Regular Session
HOUSE BILL NO. 326
BY REPRESENTATIVE ECHOLS
MEDICAID MANAGED CARE: Provides for certain data and other material to be
included in the Healthy Louisiana Claims Report
1 AN ACT
2To enact R.S. 46:460.91(C)(5) and (F), relative to data on processing of healthcare provider
3 claims by Medicaid managed care organizations; to provide for reports by the
4 Louisiana Department of Health to certain legislative committees of information on
5 claims processing in the Medicaid managed care program; to specify data and other
6 material to be included in such reports; and to provide for related matters.
7Be it enacted by the Legislature of Louisiana:
8 Section 1. R.S. 46:460.91(C)(5) and (F) are hereby enacted to read as follows:
9 ยง460.91. Claims processing data; reports to legislative committees
10 * * *
11 C. The report shall feature a narrative which includes, at minimum, the
12 action steps which the department plans to take in order to address all of the
13 following:
14 * * *
15 (5) Timeliness of claims payments to providers by each managed care
16 organization.
17 * * *
18 F. The quarterly reports shall feature data on timeliness of claims payments
19 by each managed care organization which, at minimum, shall include an average and
20 a median days-to-payment metric for all claims reflecting the number of calendar
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CODING: Words in struck through type are deletions from existing law; words underscored
are additions. HLS 20RS-339 ORIGINAL
HB NO. 326
1 days elapsed from the date of claim submission by the provider to the date of claim
2 payment by the managed care organization. If a claim for payment is denied in
3 whole or in part by a managed care organization, or by a fiscal agent or intermediary
4 of the organization, and the provider resubmits the claim in whole or in part and the
5 organization ultimately pays all or part of the claim, then the days-to-payment
6 metrics for that claim shall be based upon the date of submission of the original
7 claim.
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 326 Original 2020 Regular Session Echols
Abstract: Specifies data and other information related to processing of healthcare provider
claims by Medicaid managed care organizations to be included in the quarterly
Healthy Louisiana Claims Report.
Present law requires the La. Department of Health (LDH) to produce and submit to the Joint
Legislative Committee on the Budget and the House and Senate committees on health and
welfare a quarterly report entitled the "Healthy Louisiana Claims Report". Specifies the data
on healthcare provider claims submitted to Medicaid managed care organizations (MCOs)
to be included in the report.
Proposed law retains present law and adds thereto a requirement that the report feature data
on timeliness of claims payments by each MCO which, at minimum, shall include an
average and a median days-to-payment metric for all claims reflecting the number of
calendar days elapsed from the date of claim submission by the provider to the date of claim
payment by the MCO. Provides that if a claim for payment is denied in whole or in part and
the provider resubmits the claim and the MCO ultimately pays all or part of the claim, then
the days-to-payment metrics for that claim shall be based upon the date of submission of the
original claim.
Present law provides that the report shall feature a narrative which includes, at minimum,
the action steps which LDH plans to take in order to address certain issues in Medicaid
managed care.
Proposed law retains present law and adds timeliness of claims payments by MCOs as an
issue to be addressed in the report.
(Adds R.S. 46:460.91(C)(5) and (F))
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CODING: Words in struck through type are deletions from existing law; words underscored
are additions.