HB 7117 Summary

• Revises the statewide Medicaid managed care program structure by restructuring procurement regions and changing the number of eligible plans required in each region, ranging from 2 to 7 plans depending on the region.

• Requires the Agency for Health Care Administration to test provider network databases maintained by managed care plans and to impose fines and sanctions on plans that fail to comply with claim payment requirements.

• Gives preference to plans proposing to establish comprehensive long-term care plans and requires long-term care managed care plans and providers to negotiate mutually acceptable payment rates, methods, and terms rather than using agency-set rates.

• Deletes obsolete provisions related to work activity requirements and monthly Medicaid premiums, and removes provisions requiring the agency to establish nursing-facility-specific payment rates.

• Takes effect July 1, 2017.