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Bill would bar liable third parties from denying Medicaid payment solely over prior‑authorization policies
Summary
SB 361 aligns state law with a 2022 federal provision to prevent liable third‑party payers from denying payment to Medicaid solely because a prior authorization was not obtained. Office of Inspector General staff supported the bill as a concise statutory alignment; committee asked about premium and market impacts.
Senator Mike Yakawich presented Senate Bill 361 as a statutory alignment with the federal Consolidated Appropriations Act of 2022. Heather Smith, program compliance bureau chief with the Office of Inspector General, told the committee the provision increases state Medicaid recoveries by barring liable third‑party payers from refusing payment solely because a prior authorization under their rules was missing.
"Federal rules require that Medicaid is a payer of last resort," Smith said, explaining the bill would add an explicit state prohibition against denials based only on prior‑authorization absence for items and services covered under the state plan. The bill does not change third‑party rules for non‑Medicaid members.
Committee members asked whether the change could affect insurance premiums; witnesses said Medicaid recipients would not have premiums and the fiscal note frames the bill as a compliance and recovery measure. The sponsor asked for a due pass recommendation.
