House Bill No. 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 the state medical assistance program. The bill establishes specific time frames for these organizations to make determinations regarding service authorizations, ensuring that decisions are made as quickly as the enrollee's health condition requires. It mandates that managed care organizations maintain written procedures for utilization review determinations and notify both enrollees and providers of these determinations.

Additionally, the bill outlines the consequences for managed care organizations that fail to make timely determinations, prohibiting them from denying claims based on a lack of prior authorization if they do not adhere to the established time frames. It also specifies that retrospective review determinations must be completed within thirty calendar days of obtaining necessary clinical documentation. Overall, the proposed changes aim to streamline the utilization management process and enhance the efficiency of service authorizations in the Medicaid program.

Statutes affected:
HB915 Original: