General Assembly Substitute Bill No. 5459 is a legislative proposal aimed at increasing Medicaid reimbursement rates for certain healthcare providers. The bill, effective from July 1, 2024, mandates the implementation of phase one recommendations from a Medicaid rate study for select providers, which include behavioral health services, physician specialty services, autism services, and dental services. The bill outlines specific adjustments to the reimbursement rates, such as developing new rate methodologies based on cost information and market factors, aligning rates with Medicare or a five-state rate benchmark (average rates from Maine, Massachusetts, New Jersey, New York, and Oregon), and creating incentives for service delivery and accurate medical coding.

Additionally, the bill 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 raising the flat Medicaid billing rate for birth-to-three program services. It also appropriates funds for increasing Medicaid rates for medical and dental services provided by federally qualified health centers. Studies are mandated to compare Medicaid reimbursement rates for durable medical equipment and podiatry services with the five-state rate benchmark and Medicare rates, with reports due by October 1, 2024. The bill also introduces policies for Medicaid reimbursement for electronic consultations (E-Consults) to improve access to care. The bill contains several new sections effective from passage or from July 1, 2024, and does not include any deletions from current law.