This bill amends sections 68-995 and 68-996 of the Revised Statutes Cumulative Supplement, 2024, to establish new requirements for contractors providing medical assistance services under the Medical Assistance Act. Key provisions include a cap on administrative spending at twelve percent, a definition of annual contractor profits limited to a maximum of three percent, and a minimum medical loss ratio of eighty-five percent. Additionally, contractors are prohibited from reducing Medicaid rates, imposing restrictive treatment limitations for mental health and substance use disorder services, and must maintain an adequate provider network. The bill also mandates that contractors apply recognized care standards and make utilization review policies publicly available.

Furthermore, the bill creates the Medicaid Managed Care Excess Profit Fund, which will contain funds returned to the State Treasurer and will be used to offset losses and address health needs for adults and children under the Medical Assistance Act. The Division of Medicaid and Long-Term Care is tasked with ensuring contractor compliance with applicable laws, making public various reports, and ensuring access to mental health and substance use disorder services. The bill aims to enhance transparency, accountability, and service quality within the state's medical assistance program.

Statutes affected:
Introduced: 68-995, 68-996