HB 538: AN ACT relating to Medicaid managed care organizations.

Official summary

Abstract published by the legislature (via Open States). Text as published by the legislature; reproduced verbatim.

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.

Sponsors

Sponsors by party (alphabetical): Republican 2

“Support” is shown only as formal sponsorship recorded by the legislature. Roll-call votes are available on the official bill page.

Recent official actions

1. February 9, 2026to Health Services (H)
2. February 2, 2026to Committee on Committees (H)
3. February 2, 2026introduced in House