SB 209 — AN ACT relating to health care.

UNOFFICIALCHAPTER COPY130 231 RSCHAPTER 130 ( SB 209/EN209 ) AN ACT relating to health care.

(f) "Person" means a natural person, corporation, mutual company, Page 1 of 9 SB020920.100 - 1515 - XXXX 3/16/2023 6:04 PM Engrossed UNOFFICIAL COPY 23 RS SB 209/EN unincorporated association, partnership, joint venture, limited liability company, trust, estate, foundation, nonprofit corporation, unincorporated organization, government, or governmental subdivision or agency;

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or Page 2 of 9 SB020920.100 - 1515 - XXXX 3/16/2023 6:04 PM Engrossed UNOFFICIAL COPY 23 RS SB 209/EN (d) Impose a penalty on a pharmacy for complying with this section.

(4) If the application of any requirement of subsection (2)(b) of this section would be the sole cause of a health plan's failure to qualify as a Health Savings Account-Account-qualified qualified High Deductible Health Plan under 26 U.S.C.

Is on behalf of a provider who does not have accounts receivable Page 3 of 9 SB020920.100 - 1515 - XXXX 3/16/2023 6:04 PM Engrossed UNOFFICIAL COPY 23 RS SB 209/EN with the department;

(a) Be in compliance with KRS 205.522[,] and 205.532 to 205.536;[,] and[ 304.17A-515] CHAPTER 130 3 (b) Require participation in a credentialing alliance recognized by the department pursuant to subsection (4) of this section if such an alliance has been established or utilization of the credentialing organization designated by the department pursuant to subsection (5) of this section.

Page 4 of 9 SB020920.100 - 1515 - XXXX 3/16/2023 6:04 PM Engrossed UNOFFICIAL COPY 23 RS SB 209/EN (3) The department shall enroll a provider within sixty (60) calendar days of receipt of a clean provider enrollment application.

Perform primary source verification and credentialing committee review Page 5 of 9 SB020920.100 - 1515 - XXXX 3/16/2023 6:04 PM Engrossed UNOFFICIAL COPY 23 RS SB 209/EN of each credentialing application that results in a recommendation on the provider's credentialing within thirty (30) days of receipt of a clean application;

[(c) If on or before December 31, 2021, sixty percent (60%) or more, with any fraction of a percent rounded down, of the total number of Medicaid managed care organizations have entered into contracts with a credentialing alliance, the procurement provisions of this section shall be null and void and the department shall discontinue any contracts for credentialing verification services so that each Medicaid managed care organization shall bear its own costs for provider credentialing.] (5) (a) If a credentialing alliance has not been established and recognized by the department pursuant to subsection (4) of this section by December 31, 2023, the department shall, through a request for proposals and in accordance with KRS Chapter 45A, designate a single credentialing verification Page 6 of 9 SB020920.100 - 1515 - XXXX 3/16/2023 6:04 PM Engrossed UNOFFICIAL COPY 23 RS SB 209/EN organization to verify the credentials of providers on behalf of all managed care organizations.

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(7)[(4)(7)[(4)(a) (a) The department shall enroll a provider within sixty (60) calendar days of receipt of a clean provider enrollment application.

The time limits established in this section shall be tolled or paused by a Page 7 of 9 SB020920.100 - 1515 - XXXX 3/16/2023 6:04 PM Engrossed UNOFFICIAL COPY 23 RS SB 209/EN delay caused by an external entity.

(a)[1.](a)[1.]Determine Determine whether it will contract with the provider within thirty (30) calendar days of receipt of the verified credentialing information from a credentialing verification organization either designated by the department or contracted by managed care organizations as part of a credentialing alliance;

and (b)[2.](b)[2.]1.[a.] 1.[a.]WithinWithin ten (10) days of an executed contract, ensure that any internal processing systems of the managed care organization have been updated to include:

and b.[ii.]Theb.[ii.] The provider as a participating provider.

2.[b.]In2.[b.] In the event that the loading and configuration of a contract with a provider will take longer than ten (10) days, the managed care organization may take an additional fifteen (15) days if it has notified the provider of the need for additional time.

(9)[(6)] (a) For the purpose of reimbursement of claims, once a provider has met the terms and conditions for credentialing and enrollment, the provider's Page 8 of 9 SB020920.100 - 1515 - XXXX 3/16/2023 6:04 PM Engrossed UNOFFICIAL COPY 23 RS SB 209/EN credentialing application date shall be the date from which the provider's claims become eligible for payment.

(10)[(7)] Nothing in this section shall prohibit a university hospital, as defined in KRS 205.639, from performing the activities of a credentialing verification organization for its employed physicians, residents, and mid-level practitioners where such activities are delineated in the hospital's contract with a Medicaid managed care CHAPTER 130 5 organization.

PageBecame 9law ofwithout 9Governor's SB020920.100signature -March 151529, -2023. XXXX 3/16/2023 6:04 PM Engrossed

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