Senate
File
359
-
Introduced
SENATE
FILE
359
BY
JOCHUM
A
BILL
FOR
An
Act
relating
to
the
credentialing
and
recredentialing
of
1
Medicaid
providers
by
a
single
state-procured
credentialing
2
verification
organization.
3
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
4
TLSB
2453XS
(2)
88
pf/rh
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
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2453XS
(2)
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pf/rh
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