Bill > H1270

This bill aims to standardize the administration of Medicaid medical necessity reviews across the state. It defines key terms like "adverse determination" and "clinical peer reviewer" to ensure consistent evaluation of healthcare services. The bill requires the state Medicaid division to provide written justification for any adverse determinations, including the specific information used, the patient's condition and treatment, and the clinical rationale. It also mandates a reconsideration process where the provider can discuss the adverse decision with a clinical peer reviewer within one business day. This process is intended to improve transparency and allow providers to challenge denials before going through the full appeals process.

Health and Social Services

https://malegislature.gov/Bills/192/H1270