House Bill No. 915, introduced by Representative Dickerson, amends R.S. 46:460.74 to replace the prior authorization process with a utilization management process for managed care organizations within Louisiana's Medicaid program. The bill establishes specific time frames for these organizations to make determinations regarding service authorizations, requiring that decisions be made as quickly as the enrollee's health condition necessitates, but no later than the time frames outlined in the bill. It also mandates that managed care organizations maintain written procedures for making utilization review determinations and notifying both enrollees and providers of these decisions.

Additionally, the bill stipulates that if a managed care organization fails to make a determination within the specified time frames, it cannot deny claims based on a lack of prior authorization. The proposed law includes provisions for expedited authorization determinations in urgent situations, as well as guidelines for retrospective review determinations. Key changes include extending the time frame for standard service authorization determinations from five business days to seven calendar days and allowing for extensions under certain conditions. Overall, the bill aims to streamline the utilization management process and enhance the efficiency of service authorizations in the Medicaid program.

Statutes affected:
HB915 Original:
HB915 Engrossed:
HB915 Reengrossed: