There are some differences between the House and Senate Medicaid Tech bills. Representative Joey Hood–Chairman of the House Medicaid Committee–is confident he and Senate Medicaid Chair Kevin Blackwell will get things worked out.
Crossover Claims:
“The senate bill has a reduction in crossover claims, the house bill does not,” Hood explained. “That’s when Medicare pays 80% and Medicaid picks up the extra 20%. We don’t have that in the house bill, I figure that will be an issue as we go to conference.” Hood says that would cost around $20-$30 million dollars. “That would cut the hospitals that much.”
Bariatric Surgery:
Another sticking point has been senate efforts to cover bariatric surgery. Hood says, “I understand the need of it. I don’t know if the taxpayers want to be on the hook for bariatric surgery. If we decide to put bariatric surgery in, the division is going to have to make it very strict. I think it’s $5-million on the federal share, and $1-million state share.”
Credentialing:
Then there is credentialing. “Back in 2018 when the past tech bill was done, we inserted language regarding credentialing. After we passed it, we were informed that the division couldn’t do it, even though it was directly in the statute. And so we’ve had providers that came up to us and said MCO’s (Managed Care Organization’s) are ignoring it. It’s like they have a blindfold on, close their eyes, or have an eye patch.” Credentialing is when providers try to enroll in the 3 managed care companies. “And so what we want to do is do a uniform process. That way when you enroll with one credentialing company, you enroll with all three. What the house version did is put a time limit on it. You’ve got 60 days to make a decision on whether you’re going to be enrolled in that program. If you don’t make a decision in that 60 days, you’re automatically credentialed and enrolled.”
Failure to make timely payments:
Hood says the house addressed MCO’s failure to pay timely payments. “Once they provide all the information, you’ve got 60 days to make a determination of whether the claim should be paid. If it’s not done within 60 days then you pay the claimant in full. If not, then you issue a denial letter. If you issue a denial letter, then you have to give a reason why it was denied. We were told that some providers were receiving just denied. And what happens after it’s denied is, it just sits out there and nothing’s done. So, we inserted some language that the division will have a hearing within 60 days.”
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