208.437. Reimbursement allowance period--notification of balance due, when--delinquent payments, procedure, basis for denial of licensure--expiration date. - Missouri Statutes

Reimbursement allowance period--notification of balance due,when--delinquent payments, procedure, basis for denial oflicensure--expiration date.

208.437. 1. A Medicaid managed care organization reimbursementallowance period as provided in sections 208.431 to 208.437 shall be fromthe first day of July to the thirtieth day of June. The department shallnotify each Medicaid managed care organization with a balance due on thethirtieth day of June of each year the amount of such balance due. If anymanaged care organization fails to pay its managed care organizationreimbursement allowance within thirty days of such notice, thereimbursement allowance shall be delinquent. The reimbursement allowancemay remain unpaid during an appeal.

2. Except as otherwise provided in this section, if any reimbursementallowance imposed under the provisions of sections 208.431 to 208.437 isunpaid and delinquent, the department of social services may compel thepayment of such reimbursement allowance in the circuit court havingjurisdiction in the county where the main offices of the Medicaid managedcare organization are located. In addition, the director of the departmentof social services or the director's designee may cancel or refuse toissue, extend or reinstate a Medicaid contract agreement to any Medicaidmanaged care organization which fails to pay such delinquent reimbursementallowance required by sections 208.431 to 208.437 unless under appeal.

3. Except as otherwise provided in this section, failure to pay adelinquent reimbursement allowance imposed under sections 208.431 to208.437 shall be grounds for denial, suspension or revocation of a licensegranted by the department of insurance, financial institutions andprofessional registration. The director of the department of insurance,financial institutions and professional registration may deny, suspend orrevoke the license of a Medicaid managed care organization with a contractunder 42 U.S.C. Section 1396b(m) which fails to pay a managed careorganization's delinquent reimbursement allowance unless under appeal.

4. Nothing in sections 208.431 to 208.437 shall be deemed to effector in any way limit the tax-exempt or nonprofit status of any Medicaidmanaged care organization with a contract under 42 U.S.C. Section 1396b(m)granted by state law.

5. Sections 208.431 to 208.437 shall expire on September 30, 2011.

(L. 2005 S.B. 189, A.L. 2006 S.B. 822, A.L. 2007 S.B. 4, A.L. 2009 H.B. 395 merged with H.B. 740)

Effective 6-26-09 (H.B. 740)

7-10-09 (H.B. 395)

Expires 9-30-11