House Bill No. by Representative Chenevert aims to enhance the Medicaid managed care system by establishing an independent claims review process specifically for providers within the Coordinated System of Care (CSoC). The bill amends existing law to include a new definition for CSoC, which focuses on addressing the needs of young individuals facing significant behavioral health challenges and their families. Additionally, it clarifies that adverse determinations related to individuals enrolled in the CSoC or Medicaid are eligible for independent review, expanding the scope of current provisions that previously only applied to Medicaid enrollees.

The bill also introduces a definition for "managed care organization," which encompasses entities contracted to administer the CSoC program. This legislative change is designed to ensure that providers within the CSoC have the right to an independent review of claims, thereby promoting accountability and transparency in the Medicaid managed care system. The amendments and new insertions reflect a commitment to improving services for vulnerable populations, particularly youth with behavioral health needs.

Statutes affected:
HB740 Original: 46:81(C)