HB 4028
Imposes requirements and restrictions on insurer and coordinated care organization audits of claims for reimbursement submitted by behavioral health treatment providers.
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Sign in to take actionPublic sentiment
Support
97%
Oppose
3%
- Introduced
- Passed House
- Passed Senate
- To Governor
- Became Law
Bill overview
This bill changes how insurance companies and coordinated care organizations review claims for behavioral health treatment. It requires insurers to provide detailed instructions to providers about how to successfully resolve claims and limits how far back they can audit claims (generally no more than 12 months for paid claims or 6 years for suspected fraud). The bill also mandates that insurers report on their compliance with behavioral health parity requirements and restricts audits to ensure they are applied consistently.
Sponsors
Official sponsors from legislative records.
Primary sponsors
Cosponsors
Arguments in favor
Reasons to support this legislation.
Supporters of House Bill 4028 express concern about the impact of insurance audits on small and independent mental health providers, citing financial instability and stress due to unclear standards and punitive measures. They argue that these power imbalances threaten provider sustainability and patient access to care. The bill aims to address this imbalance by establishing clearer standards, reasonable safeguards, and protections against predatory practices, including retroactive denials and recoupments. By promoting transparency and accountability in insurance audit practices, the bill seeks to reduce administrative burden on providers and promote high-quality care without fear of financial instability.
Source: Testimony Summaries
Arguments opposed
Reasons to oppose this legislation.
concerns that House Bill 4028 moves too far away from ensuring program integrity and accountability, with some citing existing compliance plans that align with Medicare standards as models for balance. They argue that state-level constraints on audits would conflict with federal Medicaid integrity requirements, potentially leading to improper payments and fraud investigations. Additionally, testifiers worry that the bill's proposed reductions in administrative burden could compromise program integrity and accountability, while also acknowledging the need to ensure accurate billing and protect vulnerable populations, such as behavioral health professionals who may be intimidated by audit practices.
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