Bill > H1196

This bill aims to establish national standards for administering Medicaid medical necessity reviews. It introduces definitions for "adverse determination" and "clinical peer reviewer" to ensure that medical necessity decisions are made by qualified healthcare professionals who follow evidence-based guidelines. The bill also requires the state Medicaid division to provide written justification for any adverse determinations and to offer providers an opportunity for reconsideration within one working day. This process is intended to improve transparency and accountability in Medicaid medical necessity reviews.

Health and Social Services

https://malegislature.gov/Bills/193/H1196