KY HB538

Requires Medicaid managed care organizations (MCOs) to maintain websites displaying provider relations representatives' contact information for behavioral health, physical health, and contract changes, with plain-language explanations of internal appeals and external review processes

Extends the deadline for providers to file grievances or appeals from 60 days to 120 days after receiving notice of a claim reduction or denial, and requires MCOs to resolve appeals within 30 days or face fines or automatic reversal of the denial

Establishes detailed provider audit requirements including written notification, minimum 30-60 day response periods, a 2-year lookback limit, 180-day audit completion deadline, and prohibits recoupment until appeals are exhausted

Mandates MCOs report monthly to the department on claims data, authorization requests, appeals, and grievances; requires the department to submit annual reports to the legislature by December 15 beginning in 2026

Requires authorization decisions within 72 hours for expedited requests (including all substance use disorder treatment) and 2 business days for standard requests, with substance use disorder requests automatically classified as expedited