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Committee passes bill to extend Medicaid appeals deadline from 35 to 65 days
Summary
The Senate Insurance & Commerce Committee approved Senate Bill 257 to lengthen the time providers have to respond to Medicaid claim denials from 35 to 65 days and to require publication of appeals protocols online.
The Senate Insurance & Commerce Committee voted to pass Senate Bill 257, which would extend the period Medicaid providers have to respond to a denial of a claim from 35 days to 65 days and require that the agency’s appeals information and protocols be posted online.
The change, presented by Simon Dobritsoff of Highlands Oncology Group, is intended to give clinics more time to investigate denials and assemble appeals. "We have about a hundred letters from different insurance companies that come in every day," Dobritsoff told the committee, saying staff at larger practices typically assign two people to handle Medicaid appeals. He said the extended timeline is also needed when emergencies — such as tornadoes — delay a clinic’s ability to open mail and respond within the current window.
Dobritsoff described the proposal as an administrative simplification. He said practices currently use workarounds to reopen claims but that those processes add work for both providers and the state. He also told the committee that about "30% of drugs that we dispense" are reimbursed below acquisition cost, and that providers sometimes absorb losses to serve patients.
Sen. Boyden questioned the magnitude of the administrative burden and the cost to clinics. Sen. Johnson asked whether the 35-day limit is set by statute or rule; committee testimony identified the 35-day requirement as being set in agency rule, and supporters said the bill would require the agency to change that rule to reflect a 65-day timeline.
Dobritsoff told the panel that other insurers customarily provide at least 90 days for response and that some contracts allow 120 days, and argued that the bill’s 65 days would still fall short of that industry standard.
Sen. Penzo moved to pass the bill; Sen. Boyd seconded. The committee approved the measure by voice vote. The motion record shows a voice vote; no roll-call tally was provided in the transcript.
The committee moved next to House Bill 1378.
