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Committee introduces RS 31796 to align Medicaid prior‑authorization rules with federal law
Summary
RS 31796, introduced to the House Health and Welfare Committee, would implement a federal requirement ensuring Medicaid remains the payer of last resort and that other responsible payers cannot deny payment solely because of a missing prior authorization, department staff said.
Jared Larson presented RS 31796 as a response to the Consolidated Appropriations Act of 2020 and explained that the measure addresses third‑party payer authorizations in the Medicaid program.
Larson said the federal law requires states to have protections ensuring that responsible third‑party payers other than Medicaid cannot refuse payment for an item or service solely on the basis that the item or service did not receive prior authorization when Medicaid has authorized that item or service. "What this bill does in essence... guarantees that Medicaid remains, as it always should be, the payer of last resort," Larson said, describing scenarios where private insurance might deny authorization though Medicaid would cover the service.
Representative Healy moved to introduce RS 31796. The committee adopted the motion by voice vote; the chair announced the motion carries and no opposition was recorded. The presenter said the department is available to discuss scenarios and additional details at a printed hearing.
If printed, the bill will be reviewed in more detail at a committee bill hearing and the department will explain implementing language and examples.
