Senate Bill 16-120 Summary

• State Department of Health Care Policy and Financing must develop and implement an Explanation of Benefits for Medicaid recipients by July 1, 2017, to help clients identify provider errors and fraudulent claims.

• Explanation of Benefits must be provided for all acute and long-term care services under fee-for-service models and must include client name, provider name, service description, billing code, date of service, and at least one verbal and one written method to report errors.

• State Department must develop the form in conjunction with Medicaid clients and advocates to ensure understanding, and must provide explanations at least once every two months if services were rendered, using cost-effective distribution methods including email or web-based options.

• $38,800 is appropriated for the 2016-17 fiscal year ($35,350 from general fund and $3,450 from hospital provider fee fund), with an additional anticipated $149,200 in federal funds to implement the program.

• Act takes effect August 10, 2016, unless subject to a referendum petition, in which case it requires approval by voters at the November 2016 general election.