Bill > HB2538

This bill modifies administrative procedures for appeals related to MO HealthNet (Missouri's Medicaid program) by expanding the scope of potential appellants to include a new "Missouri Medicaid audit and compliance unit" alongside existing divisions like the family support division and children's division. The bill outlines detailed procedures for how individuals and service providers can appeal decisions regarding medical assistance benefits, including timelines for filing appeals (such as a 10-day window for appealing proposed benefit reductions and a 90-day window for appealing closed cases), requirements for providing fair hearings, and provisions for how those hearings will be conducted. The bill specifies that appellants have the right to be present at hearings, introduce evidence, and have a detailed explanation of the decision, and it also establishes procedures for service providers to challenge denied claims or reimbursements, including a requirement that claims must typically exceed $500 to be eligible for a hearing before the administrative hearing commission. Additionally, the bill allows for collective action by providers with similar claims and sets specific conditions under which a stay order might be granted during an appeal, including requirements for posting a bond and demonstrating potential immediate harm or a reasonable likelihood of success in the appeal.

https://house.mo.gov/Bill.aspx?bill=HB2538&year=2026&code=R