Administrative Services Organizations – Requirements for Retraction, Repayment, or Mitigation of Claims
Impact
The bill introduces mandatory requirements for ASOs to retain independent auditors to confirm any amounts claimed from health care providers, ensuring that providers have all necessary information for claims processing. Additionally, it stipulates that the ASOs bear the costs associated with these audits, preventing these expenses from being passed to the state. This change aims to alleviate financial burdens on health care providers, particularly in light of disruptions caused by the COVID-19 pandemic.
Summary
Senate Bill 549 aims to reform the operational oversight of administrative services organizations (ASOs) responsible for administering specialty mental health services within the Maryland Medical Assistance Program. This legislation specifically prohibits these organizations from retracting, requiring repayment of, or seeking mitigation of claims made by health care providers without providing the necessary documentation and information to the providers. This move seeks to enhance transparency and accountability in the claims process related to mental health services.
Enactment
As an emergency measure, SB549 is set to be enacted immediately upon approval by the General Assembly and is designed to expire two years after its implementation. This temporary nature serves to address immediate concerns while allowing for assessment and adaptation of the legislation based on its effectiveness in protecting the interests of health care providers in the specialized mental health field.
Contention
There were discussions regarding the implications of this bill, particularly about the balance of power between health care providers and administrative services organizations. Proponents argue that the bill offers much-needed protection for providers who might otherwise face unjust claims or retroactive repayments without appropriate justification. On the other hand, concerns have been raised that burdensome regulations could hinder the swift administration of mental health services, especially during emergency periods like the COVID-19 pandemic, possibly impacting the availability and efficacy of crucial health services.