House Bill No. by Representative Dickerson amends R.S. 46:460.74 to establish a utilization management process for the state medical assistance program. The bill introduces new guidelines for managed care organizations (MCOs) regarding the time frames for making determinations on service authorizations. Specifically, MCOs are required to maintain written procedures for utilization review determinations and must notify enrollees and providers of their decisions within specified time frames. The bill also stipulates that if an MCO fails to make a determination within the established time frames, they cannot deny claims based on a lack of prior authorization.

Key provisions include the requirement for MCOs to make standard service authorization determinations within seven calendar days, with expedited determinations for urgent cases to be made within 72 hours. Additionally, the bill mandates that MCOs provide written notice of any denial of prior authorization requests within two business days and outlines the necessary information that must be included in such notices. The legislation aims to enhance the efficiency and transparency of the utilization management process, ensuring timely access to medical services for enrollees.

Statutes affected:
HB915 Original:
HB915 Engrossed:
HB915 Reengrossed:
HB915 Enrolled:
HB915 Act 572: