The proposed bill amends the Medicaid Fairness Act to clarify definitions and ensure that all rule enforcement actions are appealable. Specifically, it modifies the definition of "adverse action" to indicate that an agency decision can be considered adverse if it has a direct monetary consequence to the provider, including enforcement actions. Additionally, the bill introduces a new definition for "enforcement action," which refers to actions or decisions by the department that affect Medicaid providers regarding rule enforcement.
Furthermore, the bill establishes new requirements for adverse actions resulting from enforcement actions. It mandates that providers receive at least 48 hours' notice for scheduled routine monitoring visits, while investigations of third-party complaints do not require prior notice. Providers are granted the right to challenge violations through a reconsideration request, which must be ruled upon within 30 days. If the ruling is not made in that timeframe, the violation is vacated by law. If the reconsideration is denied, providers can then appeal the violation administratively.
Statutes affected: HB 1172: 20-77-1702(2), 20-77-1702