Relating to Medicaid program improvements, providing an appropriation, and including effective date provisions

The department shall ensure that any such program developed is administered in a coordinated and collaborative manner across all contracting MCOs and shall require the MCOs to submit quarterly progress and outcomes reports to the department. Division III of the bill establishes an external review process for Medicaid providers for the review of final adverse determinations of the MCOs’ internal appeal processes. The division provides that a final decision of an external reviewer may be reviewed in a contested case proceeding pursuant to Code chapter 17A, and ultimately is subject to judicial review. Division IV of the bill relates to member disenrollment for good cause during the months of closed enrollment between open enrollment periods. Currently, a member may request disenrollment for good cause initially through their MCO’s grievance process, which may take up to to days to process. The bill requires DHS to adopt administrative rules and contractually require all Medicaid MCOs to issue a decision in response to a member’s request for disenrollment for good cause within days of the date the member submits the request to the MCO utilizing the MCO’s grievance process. Division V of the bill requires the DHS to develop uniform authorization criteria for, and to utilize a request for proposals process to procure a single credentialing verification organization to be utilized in credentialing and recredentialing providers for the Medicaid managed care and fee-for-service payment and delivery systems. The bill requires DHS to contractually require all Medicaid managed care organizations (MCOs) to apply the uniform authorization criteria and to accept verified information from the single credentialing verification organization procured by the state, and to contractually prohibit the MCOs from requiring additional credentialing information from a provider in order to participate in the Medicaid managed care organization’s provider network. Division VI of the bill relates to the office of long-term care ombudsman (OLTCO) and the Medicaid managed care ombudsman program (MCOP).50 FTEs in addition to any other full-time equivalent (FTE) positions authorized for, the OLTCO for the purposes of the MCOP. The funding appropriated and the FTE positions authorized under the bill are in addition to any other funds appropriated from the general fund of the state and actually expended, and any other FTE positions authorized and actually filled as of July 1, 2020, for the MCOP.50. The bill requires that any funds appropriated to and any full-time equivalent positions authorized for the OLTCO for the MCOP for fiscal year 2020-2021 shall be used exclusively for the MCOP. The additional FTE positions authorized in the bill for the MCOP shall be filled no later than September 1, 2020. The bill requires the OLTCO to include in the MCOP report, on a quarterly basis, the disposition of resources for the MCOP including expenditures and a full-time equivalent positions summary for the prior quarter.