General Assembly Substitute Bill No. 5459, enacted in the February Session of 2024, is designed to increase Medicaid reimbursement rates for certain providers. The bill defines key terms such as "Medicaid rate study," "select providers," and "five-state rate benchmark," which refers to the average rates for services in Maine, Massachusetts, New Jersey, New York, and Oregon. The bill mandates that, within available appropriations, the Commissioner of Social Services implement phase one recommendations of the Medicaid rate study for select providers. This includes developing new rate methodologies for behavioral health services, adjusting physician specialist service rates to a specified percentage of Medicare rates, adjusting autism direct service rates to the five-state rate benchmark, and adjusting dental service rates to achieve payment parity and incentivize service delivery and correct coding.

The bill also includes provisions for increasing the per diem rate for chronic disease hospitals, amending the Medicaid state plan to increase reimbursement rates for certain services, and increasing the flat Medicaid billing rate for birth-to-three program services. Additionally, it appropriates funds for increasing Medicaid rates for medical and dental services provided by federally qualified health centers. Studies are required to compare Medicaid reimbursement rates for durable medical equipment and podiatry services to the five-state benchmark and Medicare rates, with reports due by specific dates. The bill also introduces policies for Medicaid reimbursement for Electronic Consultations (E-Consults) to improve access to care. The act includes several effective dates for its various sections and amends corresponding sections of the law, with legislative commissioners making minor adjustments for accuracy.