Bill > SB5124

This bill establishes network adequacy standards for skilled nursing facilities and rehabilitation hospitals within managed care contracts for medical assistance programs, aiming to increase patient access to timely and medically necessary postacute care. The authority, which refers to the state agency responsible for administering these programs, must develop these standards by January 1, 2028, considering factors like provider availability, timeliness of care, and compliance with federal Medicaid regulations. For nursing homes, standards will prioritize keeping care local to an enrollee's community, with geographic limits no broader than a managed care organization's contracted regional service area. For inpatient rehabilitation facilities, geographic thresholds will not be narrower than the contracted regional service area. The development process will include obtaining feedback from stakeholders such as hospitals, nursing homes, and managed care organizations. Importantly, these new standards will be incorporated into managed care organization contracts effective on or after July 1, 2028, and will be part of the existing monitoring and reporting requirements for network adequacy.