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Committee introduces RS to ensure Medicaid remains payer of last resort for prior authorizations
Summary
RS 31,796 would align Idaho law with the federal Consolidated Appropriations Act of 2020 by preventing third-party payers from refusing payment solely because an item already has Medicaid authorization; the Department of Health and Welfare presented the RS as a required federal assurance.
The House Health and Welfare Committee introduced RS 31,796, a drafting request concerning third-party payer authorization rules for Medicaid. Jared Larson of the Department of Health and Welfare said the RS responds to the federal Consolidated Appropriations Act of 2020 and would require state law to bar responsible third-party payers from refusing payment for an item solely because it did not obtain prior authorization from the private payer when Medicaid has authorized the service.
Larson described the measure as ensuring Medicaid remains the payer of last resort and avoiding a cycle in which private insurers deny authorization for services that Medicaid will cover. "In essence, what this bill does is guarantee that Medicaid remains, as it always should be the payer of last resort," Larson said. He said the RS would ensure that Medicaid's authorization is treated as sufficient prior authorization in cases where both private insurance and Medicaid cover a service. Representative Healy moved to introduce RS 31,796; the committee voted by voice and the chair announced the motion carried.
Larson said the department would provide more detail if the RS is printed for a formal bill hearing. The committee did not discuss fiscal impacts or provide stakeholder comment during the floor introduction.
