Medicaid Prior Authorization And Recovery Of Payment
The act prohibits a prepaid inpatient health plan from:
- Requiring prior authorization for outpatient psychotherapy services;
- Retroactively recovering provider payments if a recipient was initially determined to be eligible for medical benefits or the prepaid inpatient health plan makes an error processing the claim but the claim is otherwise accurately submitted by the provider; and
- Retroactively recovering provider payments after 12 months from the date a claim was paid, except in certain circumstances.
If a prepaid inpatient health plan retroactively recovers a provider payment that is equal to or greater than $1,000, the act requires the prepaid inpatient health plan to work with the provider to develop a payment plan if the provider requests a payment plan.
(Note: This summary applies to this bill as enacted.)