No. SB 568
Filed under Healthcare.
Managed Care Plans; Revising Medicaid managed care contract requirements to prohibit managed care plans from reviewing certain prior authorization claims for medical necessity; requiring that managed care plans provide coverage for durable medical equipment and complex rehabilitation technology from a qualified provider, from within the provider network, of the enrollee’s choosing, etc.
Plain English Summary
AI-GENERATEDOnce a Medicaid managed care plan grants prior authorization for equipment, supplies, or services, it can no longer deny payment later by claiming the care wasn't medically necessary.
Enrollees who need durable medical equipment or complex rehabilitation technology gain the right to choose any qualified provider within their plan's provider network, including subcontracted equipment vendors.
The Medicaid agency must adopt rules to implement this choice, including a way for enrollees to file grievances if they are denied the ability to pick their own equipment provider.
AIFor any claim where a Medicaid managed care plan already gave prior authorization, its prepayment or postpayment review may not include a medical-necessity review of that previously approved equipment, supplies, or service.
AIManaged care plans and subcontractors must cover durable medical equipment or complex rehabilitation technology, and agency rules must authorize enrollees to choose their own provider from within the network.
AIThe agency's rules must add a procedure, within the plan's existing grievance resolution process, for enrollees to complain if they believe they were denied the authority to choose their own equipment provider.