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2023 SESSION

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23101555D
SENATE BILL NO. 1270 Offered January 11, 2023 Prefiled January 10, 2023 A BILL to require the Department of Medical Assistance Services to include in its contracts with managed care organizations requirements for the collection and reporting of certain data; report. ---------- Patron-- Edwards (By Request) ---------- Referred to Committee on Rules ----------

Be it enacted by the General Assembly of Virginia:

1. § 1. That the Department of Medical Assistance Services (the Department) shall include in any contract it enters into with a managed care organization for the provision of medical assistance services provisions that require each managed care organization to collect and report to the Department data regarding (i) the number and percentage of claims that are denied and the reasons for such denials and (ii) the number and percentage of claims that required resubmission prior to payment and the reasons for such resubmissions. Such data shall be organized by major provider type, including primary care providers and urgent care centers. The Department shall examine such data and identify barriers that providers encounter when accepting and treating patients enrolled in the state plan for medical assistance services. After the Department enters into its next contract with a managed care organization for the provision of medical assistance services, the Department shall report such data and analysis by October 1 of each year to the Joint Commission on Health Care and the Joint Subcommittee for Health and Human Resources Oversight.