House Bill No. by Representative Egan amends and reenacts R.S. 46:460.75(C) through (E) and enacts R.S. 46:460.75(F) to enhance the state medical assistance program's regulations regarding provider claim payments. The bill introduces a clear definition of "extrapolation" as a mathematical technique used by managed care organizations to estimate audit results for unreviewed claims. It explicitly prohibits these organizations from using extrapolation in their audits, mandating that any payments or recoupments be based solely on actual overpayments or underpayments. Additionally, the bill clarifies that the Louisiana Department of Justice and the department itself may still use extrapolation in compliance with existing laws.

The bill also includes provisions that prevent any contractual waivers of its requirements, rendering such clauses void. It establishes that if a managed care organization or its agents violate the provisions, the department can impose penalties without prior notice of corrective action. Furthermore, it defines "electronic funds transfer" in accordance with federal standards. Overall, the bill aims to protect healthcare providers from potentially unfair audit practices while ensuring compliance with state and federal regulations.

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