SLS 18RS-453 ORIGINAL
2018 Regular Session
SENATE BILL NO. 351
BY SENATOR THOMPSON
MEDICAID. Provides relative to Medicaid managed care organizations. (8/1/18)
1 AN ACT
2 To amend and reenact R.S. 46:460.61(A) and (B) and to enact R.S. 46:460.61(D), relative
3 to Medicaid managed care organizations; to provide for Medicaid provider
4 credentialing; to provide for time lines; to provide for applicability to contracts; and
5 to provide for related matters.
6 Be it enacted by the Legislature of Louisiana:
7 Section 1. R.S. 46:460.61(A) and (B) are hereby amended and reenacted and R.S.
8 46:460.61(D) is hereby enacted to read as follows:
9 ยง460.61. Provider credentialing
10 A. Any managed care organization that requires a health care provider to be
11 credentialed, recredentialed, or approved prior to rendering health care services to
12 a Medicaid recipient shall complete a credentialing process within ninety forty-five
13 days from the date on which the managed care organization has received all the
14 information needed for credentialing, including the health care provider's correctly
15 and fully completed application and attestations and all verifications or verification
16 supporting statements required by the managed care organization to comply with
17 accreditation requirements and generally accepted industry practices and provisions
Page 1 of 2
Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions. SB NO. 351
SLS 18RS-453 ORIGINAL
1 to obtain reasonable applicant-specific information relative to the particular or
2 precise services proposed to be rendered by the applicant.
3 B.(1) Within thirty fifteen days of the date of receipt of an application, a
4 managed care organization shall inform the applicant of all defects and reasons
5 known at the time by the managed care organization in the event a submitted
6 application is deemed to be not correctly and fully completed.
7 (2) A managed care organization shall inform the applicant in the event that
8 any needed verification or a verification supporting statement has not been received
9 within sixty thirty days of the date of the managed care organization's request.
10 * * *
11 D. The provisions of this Section shall apply to any contract or
12 subcontract entered into by any Medicaid managed care organization for
13 provider credentialing services and to any contract entered into by the
14 Louisiana Department of Health for Medicaid provider credentialing services.
The original instrument and the following digest, which constitutes no part
of the legislative instrument, were prepared by Christine Arbo Peck.
DIGEST
SB 351 Original 2018 Regular Session Thompson
Present law requires Medicaid managed care organizations to complete the credentialing
process within 90 days from the date in which they receive a completed application.
Proposed law requires this process to be complete within 45 days.
Present law requires Medicaid managed care organizations to inform the applicant of all
defects and reasons the application cannot be completed within 30 days from the date in
which they receive a completed application. Proposed law requires this notice to be issued
within 15 days.
Present law requires a managed care organization to inform the provider of any missing
application information within 60 days of the managed care organization's request for the
information. Proposed law requires this notice within 30 days.
Proposed law requires the time lines of proposed law to apply to any contracts or
subcontracts entered into by the managed care organizations or the Louisiana Department
of Health for provider credentialing services.
Effective August 1, 2018.
(Amends R.S. 46:460.61(A) and (B); adds R.S. 46:460.61(D))
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.