Current law authorizes the advisory committee or the JBC, by a majority vote, to direct the state department to conduct a review of a provider rate that is not scheduled for review during that year. Effective August 1, 2023, if the state department determines the request for an out-of-cycle review cannot be conducted, the bill requires the state department to provide written notification to the advisory committee and the JBC within 30 days after the request is made stating the reasons the out-of-cycle request cannot be conducted.
Effective August 1, 2023, the bill requires the state department to utilize information made available by the state department concerning the prior authorization process and billing structure for provider rates if such information is relevant to the review in order to minimize rate disparities for services in professional classifications that are eligible for reimbursement under medicaid.
Effective August 1, 2023, the bill requires the state department to conduct a public meeting at least quarterly to inform the state department's review of provider rates.
Current law requires the advisory committee consist of 24 members. Effective August 1, 2023, the bill decreases the advisory committee to 7 members and requires the members to have proven expertise related to medicaid in one or more specific areas. The advisory committee is currently scheduled to sunset September 1, 2025. The bill moves the sunset to September 1, 2036.
On or before December 1, 2024, and each December 1 thereafter, the bill requires the advisory committee to present to the JBC an overview of the provider rate review process, a summary of the provider rates that were reviewed, and the strategies for responding to the findings of the provider rate review.
(Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)