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SB 150

Insulin price cap.

2026 Regular Session Introduced by Rodney Pol

State DHHS must seek CMS approval to raise Medicaid FFS reimbursement for MAT at OTPs to at least $15.34/hour, improving payments and access for Medicaid recipients if approved.

First reading: referred to Committee on Health and Provider Services
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Bill Summary · SB 150

SB 150 — Increase Medicaid reimbursement rates for opioid treatment program medication‑assisted treatment (BDR S-658)

Status: Introduced January 23, 2025. (Per bill file: "Pursuant to Joint Standing Rule No. 14.3.1, no further action allowed.")
Primary subject: Medicaid reimbursement for medication‑assisted treatment (MAT) provided by opioid treatment program (OTP) providers.

Purpose / intent

Require the state Department of Health and Human Services (DHHS) to seek federal approval to raise the Medicaid fee‑for‑service reimbursement rate for medication‑assisted treatment delivered by opioid treatment program providers — with a target of at least $15.34 per hour (or as close to that amount as CMS will approve).

Key provisions

  • DHHS must submit to the U.S. Secretary of Health and Human Services (CMS) a State Plan Amendment (SPA) request on or before October 1, 2025.
  • The SPA must request an increase of the fee‑for‑service reimbursement rate for MAT provided by OTPs to at least $15.34 per hour, or the closest amount CMS will approve.
  • The reimbursement request must be supported by rate‑setting methods accepted by CMS (i.e., the request should use evidentiary/accepted methodologies to justify the rate).
  • The act takes effect upon passage and approval (per the introduced version).

Who would be affected

  • Opioid treatment program (OTP) providers who furnish medication‑assisted treatment (e.g., methadone dispensing and associated clinical services) and who bill Medicaid on a fee‑for‑service basis.
  • Medicaid enrollees receiving MAT services from OTPs — potentially improved access if providers are better reimbursed.
  • State DHHS (responsible for preparing and submitting the SPA and for rate implementation if CMS approves).
  • Federal CMS (must review and approve the SPA); fiscal effects may be shared under the Medicaid federal matching framework.

Potential impacts and considerations

  • Provider payments: If CMS approves the requested rate (or a similar increase), OTPs would receive higher Medicaid FFS payments for MAT encounters, which could improve provider sustainability and access.
  • Medicaid spending: Higher reimbursement rates would likely increase state Medicaid expenditures for covered FFS MAT services. The net budget impact depends on how much of Medicaid MAT delivery is FFS versus covered through managed care, and on federal matching (FMAP). The bill does not specify an appropriation.
  • Implementation dependencies: The increase takes effect only if CMS approves the SPA; CMS may approve a different amount or request additional rate justification. The SPA must use accepted methods for rate development.
  • Scope: The introduced text targets fee‑for‑service reimbursement. States with managed‑care arrangements may need parallel contract/rate adjustments for managed‑care payment to OTPs to achieve comparable provider reimbursement.
  • Timing: DHHS must submit the SPA by October 1, 2025. CMS review and approval timing is variable.

Procedural / timeline notes

  • Introduced Jan 23, 2025. The bill text requires the SPA submission by Oct 1, 2025 and declares the act effective upon enactment.
  • Current status in the bill file: "Pursuant to Joint Standing Rule No. 14.3.1, no further action allowed." (This language appears in the supplied file; consult the legislative clerk or the chamber’s status page for the latest procedural disposition.)

Legislative references

  • Bill Draft Request: BDR S‑658
  • Key operational agencies: State Department of Health and Human Services; U.S. Department of Health and Human Services / CMS

If you want, I can:
- Draft suggested statutory language for an alternate version (e.g., covering managed‑care payments as well), or
- Prepare a short fiscal‑impact checklist your budget office could use when estimating the cost of the proposed rate increase.

Compiled from official sources — confirm details with the bill’s official record.

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