RÉSUMÉ DIGEST
ACT 482 (SB 108) 2018 Regular Session Johns
Prior law required the La. Department of Health (LDH) to produce an annual report on the
Medicaid managed care program and provides requirements for the content of the report.
Prior law required that the report include certain data concerning a specific set of health
outcomes. New law deletes prior law and requires instead that the report include a copy of
the annual external quality review technical report produced pursuant to federal Medicaid
managed care regulations.
New law provides for quarterly reporting by LDH on the Medicaid expansion population and
certain service utilization data, with a collective summary to be included in the annual
Medicaid managed care report.
New law requires that the report as to monies comprising the managed care organization's
medical loss ratio include total expenditures on patient care; total expenditures on healthcare
quality improvements; total expenditures on healthcare information technology and total
expenditures on goods and services other than patient care, healthcare quality improvements,
and healthcare information technology.
New law provides that as to information related to healthcare services provided by
healthcare providers to Medicaid enrollees enrolled in each of the managed care
organizations, information concerning pharmacy benefits delineated by each managed care
organization and by month include the average and range of times for responding to prior
authorization requests; the number of prior authorization requests denied, delineated by the
reasons for denial; and the number of claims denied after prior authorization was approved,
delineated by the reasons for denial.
New law provides for quarterly reporting by LDH on the Medicaid managed care
organizations' pharmacy benefit managers, with a collective summary to be included in the
Medicaid managed care annual report.
Effective upon signature of governor (May 25, 2018).
(Amends R.S. 40:1253.2(A)(1)(g) and (h) and (B); adds R.S. 40:1253.2(A)(3)(g)(v) - (vii),
(C) and (D))