S.F. 359 Section 1. MEDICAID PROGRAM —— USE OF UNIFORM 1 AUTHORIZATION CRITERIA AND SINGLE CREDENTIALING VERIFICATION 2 ORGANIZATION. The department of human services shall develop 3 uniform authorization criteria for, and shall utilize a 4 request for proposals process to procure a single credentialing 5 verification organization to be utilized by the state in 6 credentialing and recredentialing providers for both the 7 Medicaid managed care and fee-for-service payment and delivery 8 systems. The department shall contractually require all 9 Medicaid managed care organizations to apply the uniform 10 authorization criteria and to accept verified information from 11 the single credentialing verification organization procured by 12 the state, and shall contractually prohibit Medicaid managed 13 care organizations from requiring additional credentialing 14 information from a provider in order to participate in the 15 Medicaid managed care organization’s provider network. 16 EXPLANATION 17 The inclusion of this explanation does not constitute agreement with 18 the explanation’s substance by the members of the general assembly. 19 This bill requires the department of human services (DHS) to 20 develop uniform authorization criteria for, and to utilize a 21 request for proposals process to procure a single credentialing 22 verification organization to be utilized in credentialing 23 and recredentialing providers for the Medicaid managed care 24 and fee-for-service payment and delivery systems. The bill 25 requires DHS to contractually require all Medicaid managed 26 care organizations (MCOs) to apply the uniform authorization 27 criteria and to accept verified information from the single 28 credentialing verification organization procured by the 29 state, and to contractually prohibit the MCOs from requiring 30 additional credentialing information from a provider in order 31 to participate in the Medicaid managed care organization’s 32 provider network. 33 -1- LSB 2453XS (2) 88 pf/rh 1/ 1