House Bill 1234 

Chairman: Tom Knox

Committee: Insurance

House Sponsor: Mickey Channell

HB 1234 addresses Care Management Organizations (CMOs). The “Medicaid Care Management Organizations Act” sets out governing provisions for CMOs. CMOs will be required to obtain a certificate of authority as an HMO prior to providing or arranging health care pursuant to a DCH contract. Once certified, CMOs must comply with specified health care plan statutes. The bill addresses in detail how CMOs must handle emergency health care services, critical care access hospitals, and newborn infants. Also detailed are procedures related to provider complaints and appeals of denied claims. The Commissioner of Insurance will revoke or suspend the HMO certificate of authority or impose monetary penalties if the CMO violates or no longer meets the necessary requirements.

This bill comes to the House Floor under the Modified Structured Rule.

Chairman Knox’s opinion of this legislation:

CMOs currently do not function according to legislative intent as authorized by legislation directing the Department of Community Health to implement managed care. This bill codifies legislative intent and clarifies that CMOs shall function according to laws, rules, and regulations governing HMOs. It further clarifies the authority of the Insurance Commissioner to ensure compliance of CMO functions.