Bill > S746

This bill aims to administer national standards to Medicaid medical necessity reviews. It defines key terms such as "adverse determination" and "clinical peer reviewer," and requires the state Medicaid program to provide detailed written notifications when making adverse determinations regarding admissions, continued inpatient stays, or the availability of other healthcare services or procedures. The bill also gives providers an opportunity to seek reconsideration of these adverse determinations within one working day, though the provider can still pursue the claim through the Medicaid program's appeal process if the adverse determination is not reversed.

Health and Social Services

https://malegislature.gov/Bills/192/S746