Establishes national standards for Medicaid medical necessity reviews in Massachusetts.

The bill amends the Massachusetts General Laws to implement national standards for Medicaid medical necessity reviews. It mandates that the Division of Medical Assistance provide written notifications for adverse determinations, including clinical justifications consistent with professional medical practice. The bill also requires the division to offer reconsideration within one working day and specifies the content of the notification, including clinical practice guidelines and alternative treatment options.

Establishes national standards for Medicaid medical necessity reviews in Massachusetts.

The bill amends the Massachusetts General Laws to implement national standards for Medicaid medical necessity reviews. It mandates that the Division of Medical Assistance provide written notifications for adverse determinations, including clinical justifications consistent with professional medical practice. The bill also requires the division to offer reconsideration within one working day and specifies the content of the notification, including clinical practice guidelines and alternative treatment options.