Relating to provider reimbursements and enrollee cost-sharing payments for services provided under a managed care plan by certain out-of-network providers.
The proposed law would notably alter reimbursement structures, ensuring that patients are not penalized for receiving care from a provider who is no longer a network participant at the time services are rendered, provided the provider was in-network when care was initiated. This could result in expanded access to care for Medicaid enrollees by preventing unexpected financial burdens due to out-of-network charges. Additionally, it addresses provider-patient relationships by fostering a more stable financial framework for healthcare services as patients navigate their care options.
House Bill 1436 focuses on the reimbursement policies for out-of-network providers serving Medicaid recipients under managed care plans. One of the key components of the bill mandates that Medicaid managed care organizations must reimburse out-of-network providers at the in-network rate if those providers were included in the network directory during the enrollee's initial or re-enrollment period. This is aimed at enhancing continuity of care for patients who may have started treatment with a provider who later leaves the network.
There may be concerns regarding the potential financial impact on managed care organizations due to an increase in reimbursement obligations. Stakeholders may argue that while supports patients' continuity of care, this could lead to increased costs for Medicaid programs overall, which may necessitate adjustments in funding or compensatory measures elsewhere. Consequently, the discussion surrounding the bill may reflect a tension between patient care continuity and the fiscal sustainability of managed care organizations.