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Committee backs bill to increase transparency for Medicaid prepayment reviews after providers describe delayed payments
Summary
Senate Bill 153, a transparency measure concerning Medicaid prepayment review by managed-care organizations, advanced unanimously after providers testified about delayed payments, unclear notice and administrative costs tied to prepayment reviews.
Senate Bill 153, a bill to codify notice and due‑process requirements for Medicaid prepayment reviews by managed‑care organizations, was amended in committee and passed with a favorable report after testimony from behavioral‑health providers and legal counsel.
Sponsor Senator Craig Richardson said the bill seeks to codify notice, timelines and transparency around prepayment review procedures that review Medicaid claims before payment. "This is a transparency bill... specifically about prepayment review," Richardson said, adding the intent is not to eliminate prepayment review but to require clearer notice and guidelines so providers can respond and maintain cash flow.
Jessica Burke, chief legal officer for Addiction Recovery Care, told the committee the bill would prevent prepayment reviews from being imposed without adequate notice or explanation. "Right now, prepayment review can be put on a provider with 48 hours notice. The provider does not have to be told why that prepayment review is there," Burke said, likening the current practice to being charged without knowing the charge.
Randy Hunter, chief executive officer of Frontier Behavioral Health, described an instance where his organization learned of a 20% reimbursement change from an MCO indirectly, then received prepayment review letters that cited only "SIU initiated" as the reason and supplied a disconnected phone number for questions. Frontier filed a complaint and sought emergency relief in Jefferson Circuit Court; Hunter said payments resumed but were roughly 75 days late and the organization incurred "tens of thousands of dollars" in administrative costs.
Committee members asked whether the bill would conflict with existing contracts between the cabinet (Department for Medicaid Services) and managed‑care organizations (MCOs). Sponsor Richardson and legal counsel said the bill is intended to codify what they described as existing regulatory practices under DMS and is not intended to conflict with valid contract provisions or federal law.
Senator Douglas and other members voiced support, saying the bill addresses real operational issues that can disrupt smaller or rural providers. The committee adopted the committee substitute and voted unanimously to report the bill favorably.
Votes at a glance: Committee adopted the committee substitute and reported SB 153 favorably; recorded vote was unanimous.
Provenance: Topic introduction excerpt: "Our last bill for consideration today is Senate Bill 1 53 with the process sponsor being center Craig Richardson." (block_id: "block_1104.005", local_start:0, local_end:120, evidence_excerpt:"Our last bill for consideration today is Senate Bill 1 53 with the process sponsor being center Craig Richardson.")
Topic finish excerpt (vote): "Aye. The vote is unanimous. Senate bill 1 53 is amended. Passes with a favorable expression." (block_id: "block_2082.01", local_start:0, local_end:120, evidence_excerpt:"Aye. The vote is unanimous. Senate bill 1 53 is amended. Passes with a favorable expression.")
