A new Kentucky law removes a financial penalty that Medicaid MCO contracts could impose on primary care providers for failing to reach patients—even when the provider made a genuine effort.
Most Kentucky health services owners don't realize their Medicaid managed care organization (MCO) contracts may currently allow financial penalties if they fail to reach assigned patients by phone or other means—even when they've made a documented, good-faith attempt to contact them.
HB2, signed into law with an emergency declaration, changes that. The bill prohibits MCOs from penalizing primary care providers for unanswered patient contacts, provided the provider can show they made a genuine effort to reach the enrollee.
Section 10(1)(c) of HB2 (page 12) requires that every Medicaid MCO contract entered into, renewed, or extended on or after the effective date must include language prohibiting MCOs from imposing financial penalties on primary care providers—including solo practitioners and small independent practices—for failing to reach assigned Medicaid enrollees when the provider has made a good-faith contact effort.
This is a direct business protection. Instead of absorbing a financial hit because a patient didn't answer the phone or return a call, providers can now document their contact attempts and remain penalty-free, as long as those attempts were genuine and documented.
The provision applies specifically to primary care providers. If your practice contracts with Medicaid MCOs in Kentucky, this matters to your bottom line. Small independent practices, which often lack the administrative infrastructure of larger health systems, are particularly vulnerable to these kinds of contract penalties. This law levels that playing field.
HB2 became effective immediately upon passage and approval, with an emergency declaration noted in Section 33. The MCO contract prohibition applies to all contracts entered into, renewed, or extended on or after that effective date.
If you have an existing MCO contract that predates the law, the prohibition will apply when that contract comes up for renewal or extension. If you're negotiating a new contract now, the language must be included.
Review your current Medicaid MCO contracts to confirm whether they contain penalty language tied to patient contact outcomes. When your contracts renew, ensure the new versions include the Section 10(1)(c) language prohibiting such penalties. Document your contact attempts—this is now your protection against unfounded penalty claims.
If an MCO attempts to impose a penalty for unanswered patient contacts going forward, you have legal ground to challenge it, provided you can demonstrate good-faith contact efforts.
For a detailed, practice-specific guide to HB2's provider protections, contact your trade association or legal counsel.
Source: HB2—AN ACT relating to Medicaid, making an appropriation therefor, and declaring an emergency. Section 10(1)(c), Page 12; Section 33 (emergency declaration).