Senator Penzow and a presenting provider told the Senate Insurance & Commerce Committee that Senate Bill 2507 would extend the time providers have to respond to Medicaid claim denials from 35 days to 65 days and require the agency to publish protocols and policies online.

Simon Dobritsoff, of Highlands Oncology Group, told the committee the extension is needed to handle high volumes of denial notices and to allow practices time to investigate and respond. "We have about a hundred letters from different insurance companies that come in every day, and so we're trying to keep up with the volume," Dobritsoff said. He described the change as "an administrative simplification" that would reduce duplicate reopenings and phone calls between providers and the state.

The bill would also direct the agency to make information, protocols and policies available online so providers can read and comply with Department of Human Services requirements, Dobritsoff said. He told the committee that accessing the portal can be time-consuming for larger practices because staff must log into each clinic account individually to retrieve documents and there is no tracking mechanism for what has already been downloaded.

Committee members questioned costs and the legal basis for the change. "This sounds like a lot of bureaucracy. Do you have any idea how much this bureaucracy costs the average clinic to have to deal with all of this?" Senator Boyden asked. Dobritsoff replied that, "Just for Medicaid alone, most practices have about 2 dedicated reps, for a larger practice just working these on the back office side," and that the phone-and-reopen process creates workload on both sides. He also said some drugs are reimbursed below acquisition cost: "I think about 30% of drugs that we dispense that are below cost."

Senator Johnson asked whether the 35-day limit is set in statute or rule. Dobritsoff said, "It's currently in rule." Senator Penzow noted the bill would mandate the agency amend the rule to reflect the 65-day window.

Dobritsoff added that other insurance companies commonly provide at least 90 days for similar appeals and that some contracts he has seen include 120 days. "All other insurance companies, customarily provide 90 days minimum. So this is still even below the what the standard is for all other insurance companies," he said.

The committee voted on the bill by voice. "Motion by Senator Penzo, second by Senator Boyd," the chair announced; committee members responded "aye." The chair then declared the bill passed out of committee.

The bill text and the timeline for further legislative consideration were not specified in the committee record excerpt provided.