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Committee approves bill tightening MCO audit, notice and parity oversight for providers
Summary
The House Committee on Health Services passed House Bill 785 with a committee substitute after testimony from providers who said managed care organization audits and unilateral rate reductions have strained small and rural behavioral-health and substance-use providers.
The House Standing Committee on Health Services on Tuesday approved House Bill 785 as amended by House committee substitute 1, a bill the sponsor and provider groups said would tighten notification rules for contract amendments, set standards for managed-care audits and strengthen enforcement of mental-health parity requirements.
Representative Kim Mosier, the bill sponsor, said the substitute combines the language of House Bill 785 and 787 and seeks to improve “notification to providers about changes in contracts and denial of claims and strengthens the ability to audit claims.”
John Inman, assistant general counsel at BrightView Health, said managed-care payments for substance-use-disorder services are often far lower than comparable physical-health payments and are sometimes indexed to Medicare at levels that providers find inadequate. “We’ve seen disparity between those payments… oftentimes 50 to 60% of the Medicare rate,” Inman…
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