MA
Massachusetts House Bill H1196

Massachusetts 2023-2024 Regular Session

Massachusetts House Bill H1196

Introduced
2/16/23  

Caption

Administering national standards to Medicaid medical necessity reviews

Impact

If enacted, H1196 would amend Chapter 118E of the General Laws, thereby enhancing the framework under which adverse determinations are made. Specifically, the bill requires that medical necessity reviews provide substantiated rationales aligned with widely accepted professional medical practices. The inclusion of clinical justification for any adverse determinations promotes accountability among clinical peer reviewers and reinforces the roles of healthcare professionals in decision-making regarding patient care.

Summary

House Bill H1196 aims to establish national standards for Medicaid medical necessity reviews in Massachusetts. This bill introduces specific definitions and procedures for how medical necessity determinations are conducted by healthcare providers. The primary goal is to ensure that these reviews adhere to consistent national standards, enhancing fairness and transparency in the healthcare system for Medicaid recipients.

Contention

Discussions surrounding H1196 may center on the implications of increased oversight and standardization in Medicaid reviews. Proponents advocate for the bill as necessary for patient protection and ensuring appropriate medical care under Medicaid, while opponents may raise concerns regarding potential bureaucratic hurdles and the capacity of healthcare providers to comply with expanded standards. The dialogue could evoke broader debates on the role of state regulations in healthcare and the balance between standardization and local healthcare practices.

Companion Bills

MA S724

Similar To Administering national standards to Medicaid medical necessity reviews

MA H4634

Replaced by Study Order

Previously Filed As

MA S724

Administering national standards to Medicaid medical necessity reviews

MA H1068

To further define medical necessity determinations

MA S835

To further define medical necessity determinations

MA H1229

To further define medical necessity determinations

MA HB187

Medicaid; require managed care organizations to use certain level of care guidelines in determining medical necessity.

MA HB1002

Medical Necessity Determination Insurance Coverage

MA HB425

Medicaid; require managed care organizations to use certain level of care guidelines in determining medical necessity.

MA HB423

Medicaid; require managed care organizations to use certain level of care guidelines in determining medical necessity.

MA HB317

Medicaid; require managed care organizations to use certain level of care guidelines in determining medical necessity.

MA SB1207

Relating to the operation and administration of Medicaid, including the Medicaid managed care program and the medically dependent children (MDCP) waiver program.

Similar Bills

No similar bills found.