Updates to Medicaid

     Beginning December 1, 2026, the bill requires each transportation broker that administers nonemergency medical transportation to medicaid members to submit certain information to the department of health care policy and financing (state department) regarding transportation providers that the transportation broker contracts with. The state department is required to include this information in its annual 'SMART Act' presentation.

      The bill changes the term 'qualified alien' to 'qualified noncitizen' to align with federal requirements.

     The bill requires the medical services board to adopt rules to implement federal community engagement requirements.

     Under current law, the state department is required to reimburse an opioid treatment program for administering medication-assisted treatment in a jail setting. The bill amends this requirement to require the state department to reimburse a licensed provider who is licensed and authorized to prescribe, dispense, compound, or administer medication-assisted treatment in a jail setting.

      The bill prohibits the state department from implementing a multiple procedure payment reduction, compound billing methodology, or substantially similar reimbursement policy for outpatient therapy services.

      If the state department plans to implement, apply, or enforce new multiple procedure payment reductions for outpatient therapy services, the bill requires the state department to provide notice to the impacted providers of the changes at least 6 months prior to implementing the changes and must hold at least one stakeholder meeting to discuss the payment reductions.

      The bill authorizes the state department to adopt rules to comply with federal community engagement requirements and requires the state department make available on its website data on the community engagement requirements and their impact on medical assistance enrollment.

      Beginning January 1, 2027, the bill requires home- and community-based service agencies to submit their medical loss ratio to the state department. The state department is required to publish this medical loss ratio data on the state department's website on an annual basis.

      The bill requires the state department to collect direct care service cost to administrative cost ratio information from home- and community-based service provider agencies that serve 30 or fewer members and submit a report to the general assembly detailing the information collected.

     The bill repeals the state medical assistance and services advisory council.

(Note: Italicized words indicate new material added to the original summary; dashes through words indicate deletions from the original summary.)


(Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)