This bill amends and reenacts specific sections of the Louisiana Revised Statutes related to the state medical assistance program, specifically focusing on provider claim payments. It introduces a new definition of "extrapolation," which refers to a mathematical technique used by managed care organizations to estimate audit results for claims not reviewed. The bill explicitly prohibits managed care organizations from using extrapolation in their audits of healthcare providers, stating that any payments or recoupments must be based on actual overpayments or underpayments rather than extrapolated estimates. However, it clarifies that this prohibition does not prevent the Louisiana Department of Justice or the department from using extrapolation in compliance with existing laws.

Additionally, the bill includes provisions that ensure the requirements cannot be waived by contract, rendering any conflicting contractual clauses void. It also establishes that penalties for violations of these provisions can be imposed without prior notice of corrective action. Furthermore, the bill defines "electronic funds transfer" in accordance with federal standards, thereby enhancing clarity and compliance within the medical assistance program's payment processes.

Statutes affected:
HB786 Original:
HB786 Engrossed:
HB786 Reengrossed:
HB786 Enrolled:
HB786 Act 569: