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Bill would let DPHHS adopt Medicare fee-schedule changes automatically to speed Medicaid payments
Summary
House Bill 473 would authorize the Department of Public Health and Human Services to implement updates to the Medicare fee schedule automatically so Medicaid payment rates tied to that schedule are updated without lengthy rulemaking and mass claim adjustments; DPHHS said delays in adoption forced manual review of more than 109,000 claims in 2024.
Representative Jane Gillette introduced House Bill 473 to allow the Department of Public Health and Human Services to implement Medicare fee-schedule rate changes automatically so that Medicaid payments tied to those schedules reflect current Medicare updates without repeated rulemaking and large-scale manual claims adjustments.
Mary Lemieux, administrator for the DPHHS Health Resources Division, told the committee that delayed adoption required the department to mass-adjust 109,732 claims in calendar year 2024; 99% of those claims were suspended for manual review by fiscal agent staff, doubling staff workload. Lemieux said automatically implementing Medicare fee schedule updates would reduce the need for mass adjustments, speed provider payments and free fiscal agent staff to focus on other claims processing tasks.
Duane Pressinger and other provider witnesses said the change would benefit providers by ensuring timely reimbursement and reducing administrative burden. The sponsor said the change appears straightforward and asked the committee to pass the bill.
Ending: The hearing closed with the sponsor asking for committee passage; no opponents were recorded in the transcript.
