RÉSUMÉ DIGEST
ACT 486 (HB 655) 2024 Regular Session Miller
New law revises Medicaid third-party liability requirements to comply with the Consolidated
Appropriations Act of 2022 for prior authorizations and responses to state claim inquiries.
Existing law defines "third party" as a health and accident insurer, group health plan, service
benefit plan, hospital and medical service plan, health maintenance organization, limited
benefit health insurer, group blanket and franchise insurer, and state employee group benefit
plan.
New law states that a third party that requires prior authorization for a healthcare item or
service prior to providing that service to a person eligible for Medicaid shall accept an
authorization from the La. Dept. of Health (LDH) that the healthcare item or service is
covered under Medicaid as if LDH's authorization were a prior authorization.
New law states that a third party shall respond to any inquiry by LDH within 60 days
regarding payment for a healthcare item or service provided to an eligible individual if the
inquiry was submitted within three years from the date the healthcare item or service was
provided.
New law states that a third party shall not deny a claim submitted by LDH solely on the basis
of the date of the claim, the format of the claim, or a failure to present proper documentation
at the point-of-sale.
New law states that a third party shall not deny a claim submitted by LDH on the basis that
the department did not seek a prior authorization if the claim is submitted within three years
beginning on the date the healthcare service was provided or service made on any action
brought by LDH to enforce its rights within six years from the date that LDH submitted the
claim.
Effective upon signature of governor (May 23, 2024).
(Adds R.S. 46:446.2 (E) and (F))