HB538
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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…
Introduced: February 2, 2026
Last action: February 9, 2026
Plain-language summary
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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