Substitute House Bill No. 6091 aims to establish equitable Medicaid audit, billing, and reimbursement policies for pharmacies participating in the state Medicaid program. The bill prohibits the Department of Social Services (DSS) from denying Medicaid reimbursements based on extrapolated data derived from clerical or minor technical errors identified during audits. Additionally, it mandates the DSS commissioner to implement a receipt confirmation process for notices sent to pharmacies, maintain a reliable and updated database of the preferred drug list, and establish a grievance process by October 1, 2025, allowing pharmacies to challenge Medicaid reimbursements that do not cover their dispensing costs.

The bill introduces new legal language that emphasizes the importance of fair practices in Medicaid audits and reimbursement processes, while also deleting provisions that would allow for the denial of reimbursements based on minor errors. The grievance process must comply with the Uniform Administrative Procedures Act and enable pharmacies to present evidence of their costs in relation to disputed reimbursements. The implementation of these provisions is expected to incur costs for the DSS, including potential staffing increases to manage the new grievance process and database updates. The bill is set to take effect on July 1, 2025.