SB1851 Summary

• Establishes Child Welfare Medicaid Managed Care Implementation Advisory Workgroup to oversee transition of children in Department of Children and Family Services care to Medicaid managed care plans with representatives from youth, providers, parents, pediatricians, and other stakeholders.

• Requires Department of Children and Family Services to maintain authority over service determinations for children in care regardless of managed care involvement and to post transition plans, contracts, and prior authorization requirements on its website at least 28 days before implementation.

• Mandates Department submit annual reports to legislature on access to and quality of health care services for children in managed care, including data on continuity of care, early periodic screening services, health homes, and service complaints.

• Establishes managed care organization rate transparency requirements including data sharing with MCOs on capitation rate development, meetings in multiple locations, and budget-neutral quality incentive withholding with full return of withheld amounts based on performance.

• Amends ambulance services provisions to require Physician Certification Statements for non-emergency ground ambulance, medi-car, and service car transportation; defines medi-car and service car services; and requires standardized certification form development by Department of Healthcare and Family Services within 75 days.