SB0407: Medicaid risk based managed care.

Legislative Summary

Medicaid risk based managed care. Requires review by the budget committee before a request for proposal for the procurement of a covered population in a risk based managed care program or a capitated managed care program (program) is issued. Sets forth requirements that the office of the secretary (office) must ensure are met before the office may contract with an entity to operate a program. Sets forth provisions that must be included in a contract with an entity to operate the program. Requires the office to do the following: (1) determine all eligibility requirements; and (2) determine the base reimbursement rate structure, methodology, and reimbursement rates that are sufficient to provide an adequate number of providers to provide home and community based services. Requires a managed care organization to contract with any providers that meet specified requirements for the program. Prohibits a managed care organization from delegating or subcontracting specified functions within the program unless certain conditions are met. Requires the office to apply to amend the aged and disabled waiver to ensure that an individual in need of waiver services is authorized for reimbursable services within 72 hours of determining the individual would qualify for Medicaid and the waiver services. Expires the program on July 1, 2027. Requires the office to annually provide the budget committee information concerning the number of Medicaid recipients in certain categories and reimbursement rates for home and community based services. Allows the office of the attorney general to investigate and prosecute complaints concerning employment agencies. Provides that the division of consumer protection is responsible for the investigation of complaints concerning employment agencies.