Bill Text: IA SSB3094 | 2019-2020 | 88th General Assembly | Introduced
Bill Title: A bill for an act relating to Medicaid processes, procedures, and oversight.
Spectrum: Committee Bill
Status: (Introduced - Dead) 2020-02-12 - Subcommittee recommends amendment and passage. [SSB3094 Detail]
Download: Iowa-2019-SSB3094-Introduced.html
Senate
Study
Bill
3094
-
Introduced
SENATE
FILE
_____
BY
(PROPOSED
COMMITTEE
ON
COMMERCE
BILL
BY
CHAIRPERSON
DAWSON)
A
BILL
FOR
An
Act
relating
to
Medicaid
processes,
procedures,
and
1
oversight.
2
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
3
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DIVISION
I
1
MEDICAID
STREAMLINED
PROCESSES
AND
OVERSIGHT
2
Section
1.
MEDICAID
STREAMLINED
PROCESSES
AND
3
OVERSIGHT.
The
department
of
human
services
shall
provide
4
for
the
streamlining
of
and
consistency
in
Medicaid
program
5
processes
and
procedures
as
follows:
6
1.
For
both
fee-for-service
and
managed
care
7
administration,
prior
authorization
requirements
shall
8
be
based
on
those
established
by
the
Iowa
Medicaid
enterprise
9
and
that
resources
shall
be
available
twenty-four
hours
per
10
day,
three
hundred
sixty-five
days
per
year
to
evaluate
prior
11
authorization
requests
and
avoid
delays
in
the
provision
of
12
medically
necessary
care
and
services.
13
2.
All
Medicaid
managed
care
organizations
under
contract
14
with
the
state
shall
utilize
uniform
payment
authorization
15
criteria
and
comply
with
contract
provisions
related
to
timely
16
payment.
17
3.
All
Medicaid
managed
care
organizations
contracting
18
with
the
state
shall
provide
the
Medicaid
managed
care
19
organization’s
participating
providers
with
the
functionality
20
to
submit
and
track
all
claims,
claim
disputes,
claim
21
reconsiderations,
and
appeals
on
the
Medicaid
managed
care
22
organization’s
website
to
facilitate
participation
in
an
open
23
and
shared
provider
record.
24
DIVISION
II
25
MEDICAID
CREDENTIALING
PROVISIONS
26
Sec.
2.
MEDICAID
PROGRAM
——
USE
OF
UNIFORM
AUTHORIZATION
27
CRITERIA
AND
SINGLE
CREDENTIALING
VERIFICATION
28
ORGANIZATION.
The
department
of
human
services
shall
29
develop
uniform
authorization
criteria
and
utilize
a
request
30
for
proposals
process
to
procure
a
single
credentialing
31
verification
organization
to
be
utilized
by
the
state
in
32
credentialing
and
recredentialing
providers
for
both
the
33
Medicaid
managed
care
and
fee-for-service
payment
and
delivery
34
systems.
The
department
shall
contractually
require
all
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Medicaid
managed
care
organizations
to
apply
the
uniform
1
authorization
criteria,
accept
verified
information
from
the
2
single
credentialing
verification
organization
procured
by
the
3
state,
and
approve
or
deny
a
provider’s
credentials
within
4
sixty
days
of
receipt
of
the
request
for
approval,
and
shall
5
contractually
prohibit
Medicaid
managed
care
organizations
6
from
requiring
additional
credentialing
information
from
a
7
provider
in
order
to
participate
in
the
Medicaid
managed
care
8
organization’s
provider
network.
9
EXPLANATION
10
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
11
the
explanation’s
substance
by
the
members
of
the
general
assembly.
12
This
bill
relates
to
Medicaid
processes,
procedures,
and
13
oversight.
14
Division
I
of
the
bill
provides
for
streamlined
processes
15
and
oversight
under
the
Medicaid
program.
The
bill
requires
16
the
department
of
human
services
(DHS)
to
provide
for
the
17
streamlining
of
and
consistency
in
Medicaid
program
processes
18
and
procedures
relating
to
prior
authorization
requirements;
19
utilization
of
uniform
payment
authorization
criteria
and
20
compliance
with
contract
provisions
related
to
timely
payment;
21
and
the
submission
and
tracking
of
claims,
claims
disputes,
22
claims
reconsiderations,
and
appeals
on
the
Medicaid
managed
23
care
organization’s
website.
24
Division
II
of
the
bill
requires
DHS
to
develop
25
uniform
authorization
criteria
and
utilize
a
request
26
for
proposals
process
to
procure
a
single
credentialing
27
verification
organization
to
be
utilized
in
credentialing
and
28
recredentialing
providers
for
the
Medicaid
managed
care
and
29
fee-for-service
payment
and
delivery
systems.
The
division
30
requires
DHS
to
contractually
require
all
Medicaid
managed
care
31
organizations
to
apply
the
uniform
authorization
criteria,
32
accept
verified
information
from
the
single
credentialing
33
verification
organization
procured
by
the
state,
approve
or
34
deny
a
provider’s
application
for
credentialing
within
60
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days
of
submission
for
approval,
and
contractually
prohibit
1
the
Medicaid
managed
care
organizations
from
requiring
2
additional
credentialing
information
from
a
provider
in
order
3
to
participate
in
the
Medicaid
managed
care
organization’s
4
provider
network.
5
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