The proposed bill aims to amend the Medicaid Fairness Act by adding definitions and ensuring that all rule enforcement actions are appealable. Specifically, it modifies the definition of "adverse action" to clarify 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 or its contractors that impact 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 and allows providers to challenge violations by filing a reconsideration request. The enforcement entity is required to respond to these requests within 30 days, and if they fail to do so, the violation will be vacated by operation of law. If the reconsideration request is denied, providers have the right to appeal the violation administratively.

Statutes affected:
HB 1172: 20-77-1702(2), 20-77-1702