The proposed bill, Substitute House Bill No. 6091, aims to establish equitable Medicaid audit, billing, and reimbursement policies for pharmacies participating in the state Medicaid program. Key provisions include prohibiting 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, the bill mandates the DSS commissioner to implement a receipt confirmation process for notices sent to pharmacies, maintain an accessible database of the preferred drug list, and update this database with real-time information regarding drug approvals and denials.

Furthermore, the bill requires the DSS commissioner to create a grievance process by October 1, 2025, allowing pharmacies to challenge Medicaid reimbursements that do not cover their dispensing costs. This process must comply with the Uniform Administrative Procedures Act and enable pharmacies to present evidence of their costs in relation to the disputed reimbursements. The bill is set to take effect on July 1, 2025, and is expected to incur costs for the DSS due to the limitations on audit actions and the need for additional staffing to support the new requirements.