No. HB 1351
Filed under Healthcare.
Presumptive Medicaid Eligibility for Pregnant Women; Authorizes certain entities meeting specified criteria to serve as qualified Medicaid providers for purposes of making presumptive Medicaid eligibility determinations for pregnant women; requires DCF to ensure that such providers are adequately trained & monitored for compliance when serving in such roles; requires AHCA to provide Medicaid coverage to pregnant women deemed presumptively eligible for duration of specified time period; provides that pregnant women deemed presumptively eligible are entitled to coverage of all medically necessary services under Medicaid program during such eligibility period; requires that all prior authorizations granted before or during such period remain in effect for duration of such period; requires agency, within specified timeframe, to seek federal approval to extend allowable period of presumptive Medicaid eligibility coverage for pregnant women; requires agency & department to initiate certain rulemaking within specified timeframe.
Plain English Summary
AI-GENERATEDExpands who can determine presumptive Medicaid eligibility for a pregnant woman to include hospitals, federally qualified health centers, birth centers, nonprofit maternal health groups, WIC clinics, and local housing authorities.
These providers must meet training and certification standards, and the department must ensure they stay adequately trained and monitored for compliance with the presumptive-eligibility rules.
A pregnant woman deemed presumptively eligible is entitled to all medically necessary Medicaid services, including specialists for high-risk pregnancies, and any prior authorization already granted stays valid through that period.
Within 60 days, the state must seek federal approval to extend the presumptive-eligibility coverage window to 180 days and start the rulemaking needed to carry out these changes.
AIQualified Medicaid providers eligible to determine presumptive eligibility for pregnant women now explicitly include hospitals, federally qualified health centers, birth centers, nonprofit maternal and child health organizations, WIC clinics, and local housing authorities that meet training standards.
AIA pregnant woman deemed presumptively eligible is entitled to coverage of all medically necessary Medicaid services, including specialists and subspecialists needed to comanage a high-risk pregnancy beyond general obstetrics.
AIAny prior authorization approval granted before or during a woman's presumptive eligibility period remains valid for the entire period, so approved care does not lapse while full eligibility is being determined.
AIThe department must ensure that qualified Medicaid providers making presumptive-eligibility determinations are adequately trained and monitored for compliance with federal and state requirements.
AIPresumptive-eligibility coverage must last for the maximum period federal law allows or until a full determination is made, and within 60 days AHCA must seek federal approval to stretch that period to 180 days.