Loading chat...
IN SB0504
Bill
Status
1/14/2019
Primary Sponsor
James Merritt
Click for details
AI Summary
-
Establishes a 12-member Joint Commission on Medicaid Oversight with 6 senators and 6 representatives, requiring bipartisan representation with no more than 3 members from the same party per chamber
-
Commission responsibilities include evaluating contractor and managed care organization contract performance, proposing procedures to reduce claims processing time, overseeing nursing facility reimbursement systems, and investigating children's health insurance program implementation
-
Prohibits the Office of Medicaid Policy and Planning or its contractors from denying, delaying, or reducing payment for medically necessary services when providers made good faith efforts to verify patient eligibility through the enrollment verification system before rendering care
-
Requires the Secretary of Family and Social Services to adopt dispute resolution rules that apply to both fee-for-service and managed care programs, including extended claim filing deadlines, retroactive prior authorization, and guaranteed minimum payment rates
-
Repeals the statute specifying that Medicaid laws take precedence over insurance laws regarding managed care organizations
Legislative Description
Medicaid managed care matters. Establishes the joint commission on Medicaid oversight with the authority to meet throughout the year. Sets forth responsibilities of the commission. Repeals a statute specifying that Medicaid laws, with respect to managed care organizations, are controlling over insurance laws. Prohibits the office of Medicaid policy and planning or a contractor of the office from denying, delaying, or decreasing the amount of payment for a medically necessary covered service based on a lack of eligibility or coverage if the Medicaid provider meets certain requirements. Requires the secretary of the office of family and social services to adopt rules establishing a dispute resolution procedure for disputes between Medicaid providers and Medicaid contractors.
Last Action
First reading: referred to Committee on Health and Provider Services
1/14/2019