(a) The committee shall review, study, and make advisory recommendations concerning the following subjects:
- (1) Emergency department coverage and reimbursement to providers.
- (2) The reporting of Medicaid prior authorization denials by Medicaid managed care entities, excluding pharmacies.
(3) The reporting of Medicaid denials based on:
- (A) administrative and medically necessary criteria; or
- (B) errors or omissions made by the managed care entity.
(4) Prompt payment to providers for claims:
- (A) within thirty (30) days;
- (B) within ninety (90) days;
- (C) within one hundred eighty (180) days; and
- (D) over three hundred sixty-five (365) days.
- (5) The provider appeals process for administrative and medically necessary Medicaid denials and the resolution of appeals, including rates of reversal.
- (6) The central credentialing portal.
- (7) Policy changes to the Medicaid program with an implementation period for providers or managed care entities of more than thirty (30) days.
- (8) The reporting of Medicaid denials due to retro-eligibility status.
- (9) Other subjects, as the committee considers necessary.
(b) The committee shall, not later than November 1, 2019, study, make advisory recommendations under section 2 of this chapter, and report and make recommendations to the legislative council in an electronic format under IC 5-14-6 , concerning the feasibility of applying for a Medicaid state plan amendment for the following:
- (1) Medicaid reimbursement for health care services and school based services provided to specified individuals by a school based health center.
(2) Potential directed payments to school based health centers, including:
- (A) alternate fee schedule payments under the risk based managed care program equivalent to the fee that Medicare pays for the service, or if there is not a Medicare rate for the service, an amount determined by the office of Medicaid policy and planning; and
- (B) supplemental Medicaid reimbursement payments to qualified school based health centers under the fee for service Medicaid program.
- (c) This section expires July 1, 2021.
As added by P.L.140-2019, SEC.3. Amended by P.L.227-2019, SEC.1.