Sec. 9.5. (a) The committee shall review, study, and make advisory recommendations concerning the following subjects:

(1) Emergency department coverage and reimbursement to providers.

(2) The reporting of Medicaid prior authorization denials by Medicaid managed care entities, excluding pharmacies.

(3) The reporting of Medicaid denials based on:

(A) administrative and medically necessary criteria; or

(B) errors or omissions made by the managed care entity.

(4) Prompt payment to providers for claims:

(A) within thirty (30) days;

(B) within ninety (90) days;

(C) within one hundred eighty (180) days; and

(D) over three hundred sixty-five (365) days.

(5) The provider appeals process for administrative and medically necessary Medicaid denials and the resolution of appeals, including rates of reversal.

(6) The central credentialing portal.

(7) Policy changes to the Medicaid program with an implementation period for providers or managed care entities of more than thirty (30) days.

(8) The reporting of Medicaid denials due to retro-eligibility status.

(9) Other subjects, as the committee considers necessary.

(b) The committee shall, not later than November 1, 2019, study, make advisory recommendations under section 2 of this chapter, and report and make recommendations to the legislative council in an electronic format under IC 5-14-6, concerning the feasibility of applying for a Medicaid state plan amendment for the following:

(1) Medicaid reimbursement for health care services and school based services provided to specified individuals by a school based health center.

(2) Potential directed payments to school based health centers, including:

(A) alternate fee schedule payments under the risk based managed care program equivalent to the fee that Medicare pays for the service, or if there is not a Medicare rate for the service, an amount determined by the office of Medicaid policy and planning; and

(B) supplemental Medicaid reimbursement payments to qualified school based health centers under the fee for service Medicaid program.

(c) This section expires July 1, 2021.

As added by P.L.140-2019, SEC.3. Amended by P.L.227-2019, SEC.1.