Sen. Douglas seeks statutory fix to allow two E&M units per provider per patient per day
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Summary
Sen. Donald Douglas told the board Senate Bill 201 would correct a coding/regulatory mismatch so coverage limits could not reduce evaluation-and-management services to fewer than two units per provider per patient per day; sponsors said DMS has filed a regulatory amendment but want a statutory fix to prevent future reversals.
Sen. Donald Douglas told the Medicaid Oversight Board SB 201 is intended to improve care delivery by removing a statutory barrier that currently limits evaluation-and-management (E&M) services to one unit per physician per recipient per date of service. Douglas said the restriction forces multiple visits for different problems and reduces efficiency of care.
Cody Hunt, director of health policy for the Kentucky Medical Association, explained that the technical problem arises from language in an existing Medicaid administrative regulation (907 KAR 3005) that can be read to limit E&M services to one unit per physician per recipient per date of service. Hunt said the Department for Medicaid Services had already filed a regulatory amendment to correct coding practice, and that many MCOs already permit multiple E&M encounters, but sponsors want a statutory backstop to prevent similar policy restrictions from reoccurring.
Board members asked about fiscal impact and whether private payers already reimburse multiple E&M codes. Hunt said payment policy varies across payers and MCOs; the bill is intended to protect correct coding and not to mandate a specific reimbursement policy across MCOs. Members representing mental health and other specialties said the change supports whole-person care and reduces duplicative patient visits.
No formal board vote was taken on SB 201 during the meeting; sponsors said they would continue discussions with DMS and stakeholders about operational and payment implications.