AN ACT TO AMEND SECTION 43-13-117, MISSISSIPPI CODE OF 1972, TO REQUIRE ORGANIZATIONS PARTICIPATING IN A MANAGED CARE PROGRAM OR COORDINATED CARE PROGRAM IMPLEMENTED BY THE MISSISSIPPI DIVISION OF MEDICAID TO UTILIZE A CLEAR SET OF LEVEL OF CARE GUIDELINES IN THE DETERMINATION OF MEDICAL NECESSITY AND IN ALL UTILIZATION MANAGEMENT PRACTICES, INCLUDING THE PRIOR AUTHORIZATION PROCESS, CONCURRENT REVIEWS, RETROSPECTIVE REVIEWS AND PAYMENTS THAT ARE CONSISTENT WITH WIDELY ACCEPTED PROFESSIONAL STANDARDS OF CARE; TO REQUIRE ORGANIZATIONS PARTICIPATING IN A MANAGED CARE PROGRAM OR COORDINATED CARE PROGRAM IMPLEMENTED BY THE DIVISION TO FOLLOW CERTAIN PRINCIPLES; AND TO EXTEND THE REPEALER ON; AND FOR RELATED PURPOSES.

Statutes affected:
As Introduced: 43-13-117