MA S666

Bill

Administering national standards to Medicaid medical necessity reviews

Introduced
01/22/2019

In Committee
07/23/2020

Crossed Over

Passed

Dead
12/31/2020

Introduced Session

191st General Court

Bill Summary

For legislation to administer national standards to Medicaid medical necessity reviews. Health Care Financing.

AI Summary

This bill aims to administer national standards to Medicaid medical necessity reviews. It amends existing law by defining key terms like "adverse determination" and "clinical peer reviewer." The bill requires the state Medicaid agency to provide a written notification of any adverse determination, which must include a detailed justification based on national evidence-based medical standards and criteria. The agency must also give providers an opportunity to seek reconsideration of an adverse determination through a process involving a clinical peer reviewer within one working day. If the adverse determination is not reversed through this reconsideration process, the provider can still pursue the claim through the agency's regular appeal process.

Committee Categories

Health and Social Services

Sponsors (1)

Nick Collins (D),

Last Action

Ought NOT to pass (under Joint Rule 10) and placed in the Orders of the Day for the next session (on 07/23/2020)

Official Document

https://malegislature.gov/Bills/191/S666

(9 Companion Bills)

Version:

Document Type	Source Location
State Bill Page	https://malegislature.gov/Bills/191/S666
Bill	https://malegislature.gov/Bills/191/S666.pdf

Bill	Bill Name	Last Action	Type
H211	To establish licensing standards for drain cleaners	Bill reported favorably by committee and referred to the committee on House Ways and Means	Similar To
H2768	Providing for sustainability and transparency standards by Massachusetts business entities	Accompanied a study order, see H5103	Similar To
H2822	Increasing service quality penalty against electric and gas companies	Accompanied a study order, see H4405	Similar To
H589	Supporting evolving educational standards that allow interdisciplinary education, need-based 3R instruction, and reduced testing time	Accompanied a study order, see H5159	Similar To
S1148	Relative to medical necessity for mental health acute treatment	Committee recommended ought to pass and referred to the committee on Senate Ways and Means	Similar To
S1178	Authorizing municipal use of the prudent investor standards	Bill reported favorably by committee and referred to the committee on Senate Ways and Means	Similar To
S1411	To enhance child passenger safety	Bill reported favorably by committee and referred to the committee on Senate Ways and Means	Similar To
S2002	Relative to enhancing RPS standards	Accompanied a study order, see S2552	Similar To
S36	To lift kids out of deep poverty	Bill reported favorably by committee as changed and referred to the committee on Senate Ways and Means	Similar To

Bill > S666

MA S666

summary

Introduced Session

Bill Summary

AI Summary

Committee Categories

Sponsors (1)

Last Action

Official Document

bill text

bill summary

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