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2026 Regular Session

HB538

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AN ACT relating to Medicaid managed care organizations.

Amend KRS 205.533 to require Medicaid managed care organizations to include certain information for providers on their websites; amend KRS 205.534 to require managed care organizations to allow providers 120 days to file an appeal or grievance related to a reduction or denial of a claim; establish penalties for a managed care organization's failure to ensure the timely disposition of any appeal or grievance; require payment of any amount owed to a provider following an appeal to be paid within 30 days; require payments made following an appeal to include interest in accordance with KRS 304.17A-730 and reasonable attorney's fees; establish standards and requirements for provider audits; require the inclusion of additional information in the monthly report filed by managed care organizations; require the Department for Medicaid Services to submit an annual report to the Legislative Research Commission related to Medicaid claims, appeals, and grievances for the previous state fiscal year; authorize the Department for Medicaid Services to promulgate administrative regulations; require Cabinet for Health and Family Services or the Department for Medicaid Services to seek federal approval if they determine that such approval is necessary.

Introduced: February 2, 2026

Last action: February 9, 2026

To Health Services (H)
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This bill sets new rules for how Medicaid managed care organizations must treat healthcare providers when it comes to billing disputes and audits. It would give providers more time to appeal denied or reduced payments, require faster resolution of those appeals, and mandate that any money owed after a successful appeal be paid within 30 days with interest and attorney's fees. It also requires more detailed public reporting on Medicaid claims and appeals. Who it may affect: healthcare providers who accept Medicaid patients, such as doctors, hospitals, and clinics, as well as state agencies overseeing Medicaid.

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Legislative History

Feb 2, 2026 ·
Introduced
Feb 9, 2026 ·
To Health Services (H)

Primary Sponsor

Portrait of Kimberly Moser
Kimberly Moser

Representative · House District 064

Primary sponsor
Kimberly.Moser@kylegislature.gov
BallotpediaOfficial profile

Co-sponsors (1)

Portrait of Vanessa Grossl
Vanessa Grossl

Representative · House District 088

Co-sponsor
vanessa.grossl@kylegislature.gov