Relating to a Medicaid managed care external review process for Medicaid provider appeals

Where it is now

1. ✓
   Done: IntroducedFebruary 7, 2019
2. ✓
   Done: SubcommitteeFebruary 12, 2019
3. ✕
   Stopped: Senate committeeDied when the General Assembly ended
4. Next: Passes the Senate
5. Next: House committee
6. Next: Passes the House
7. Next: To the Governor
8. Next: Signed into law

Died when the session ended The 2020 session adjourned on June 14, 2020, the General Assembly’s last regular session. Bills that didn’t pass both chambers died. What’s a funnel?

What’s in it

This bill establishes an external review process for Medicaid providers for the review of final adverse determinations of a Medicaid managed care organization’s (MCO’s) internal appeal processes. The external review process would be available to a Medicaid provider who has been denied the provision of services to a Medicaid member or a claim for reimbursement, and who has exhausted the internal appeals process of an MCO. The bill specifies the process for the external review and provides that a final decision of an external reviewer may be reviewed in a contested case proceeding pursuant to Code chapter 17A, and is ultimately subject to judicial review.

Full bill text¹

Senate subcommittee

Named February 12, 2019. It hasn’t reported yet.

• Sen. Mark Segebart R
• Sen. Thomas A. Greene R
• Sen. Amanda Ragan D

Three legislators hear a bill first and recommend what the committee should do; it’s the best time to weigh in. How to take part