HLS 19RS-725 ENGROSSED
2019 Regular Session
HOUSE BILL NO. 434
BY REPRESENTATIVE MAGEE
Prefiled pursuant to Article III, Section 2(A)(4)(b)(i) of the Constitution of Louisiana.
MEDICAID: Provides relative to definitions, policies, and procedures of Medicaid
managed care organizations
1 AN ACT
2To enact R.S. 46:460.51(15), 460.53, and 460.54, relative to the Louisiana Medical
3 Assistance Program; to provide for a defined term; to provide a public notice
4 requirement; to provide for the implementation of a policy for the adoption of
5 policies and procedures; and to provide for related matters.
6Be it enacted by the Legislature of Louisiana:
7 Section 1. R.S. 46:460.51(15), 460.53, and 460.54 are hereby enacted to read as
8follows:
9 §460.51. Definitions
10 As used in this Part, the following terms have the meaning ascribed in this
11 Section unless the context clearly indicates otherwise:
12 * * *
13 (15) "Policy or procedure" shall mean a course or principle of action by the
14 department or a managed care organization that may have direct or indirect effect on
15 a Medicaid enrollee or healthcare provider and shall include but not be limited to
16 billing or claims submission and payment, medical management or utilization
17 review, case management, claims processing guidelines and edits, grievance and
18 appeals procedures and process, other guidelines or manuals containing pertinent
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1 information related to operations and pre-processing claims, and core benefits and
2 services.
3 * * *
4 §460.53. Contract amendments; public notice
5 A. The department, prior to executing any amendment to a professional,
6 personal, consulting, or social services contract that provides for managed care under
7 the Louisiana Medical Assistance Program through the use of a managed care
8 organization, primary care case management, prepaid inpatient health plan, or
9 prepaid ambulatory health plan, all as defined in 42 CFR 438.2, shall publish on a
10 publicly accessible page of the department's website a copy of the entire proposed
11 contract amendment and provide a public comment period of no less than thirty days.
12 B. If the department finds that an imminent peril to the public health, safety,
13 or welfare requires immediate execution of a proposed contract amendment without
14 otherwise publishing the proposed contract amendment as required in Subsection A
15 of this Section, the department may execute the proposed contract amendment upon
16 publishing a copy of the contract amendment and a written statement that details the
17 reason for finding that an imminent peril to the public health, safety, or welfare
18 requires adoption of the executed amendment.
19 §460.54. Medicaid policies and procedures; procedure for adoption
20 A. The department, prior to adopting, approving, amending or implementing
21 any policy or procedure, shall publish the proposed policy or procedure on a publicly
22 accessible page of the department's website for a period of no less than forty-five
23 days for the purpose of soliciting public comments. The proposed policy or
24 procedure shall be published in a format to be determined by the department but shall
25 include both the existing policy or procedure and the proposed policy and procedure,
26 with the proposed language in the text printed in boldface type and underscored. All
27 present policy or procedure language and punctuation which are to be deleted shall
28 be struck through.
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1 B. A policy or procedure proposed by a managed care organization shall not
2 be implemented unless approved by the department in accordance with the law,
3 regulation, or a contract after the expiration of the public notice period required by
4 this Section.
5 C. If the department finds that an imminent peril to the public health, safety,
6 or welfare requires immediate approval of a proposed policy or procedure without
7 otherwise publishing the proposed policy or procedure as required in Subsection A
8 of this Section, the department may implement the proposed policy or procedure
9 upon publishing a written statement that details its reason for finding that an
10 imminent peril to the public health, safety, or welfare requires adoption of the
11 proposed policy or procedure and a copy of the policy or procedure.
12 D. The provisions of this Section shall not apply to any policy or procedure
13 that is otherwise duly promulgated in accordance with the Administrative Procedure
14 Act or included in a duly executed contract amendment.
15 E. The department or a managed care organization shall be prohibited from
16 enforcing any policy or procedure that is not adopted in compliance with this Section
17 and any such policy or procedure shall be null and void and considered a violation
18 of the public policy of this state.
19 F. If the managed care organization makes any policy or procedure change,
20 the managed care organization shall submit the changes to the department for
21 approval within the time specified by the department.
DIGEST
The digest printed below was prepared by House Legislative Services. It constitutes no part
of the legislative instrument. The keyword, one-liner, abstract, and digest do not constitute
part of the law or proof or indicia of legislative intent. [R.S. 1:13(B) and 24:177(E)]
HB 434 Engrossed 2019 Regular Session Magee
Abstract: Defines "policy and procedure", adds a public notice requirement, and
implements a policy for adopting policies and procedures as it relates to Medicaid
managed care organizations.
Proposed law defines the term "policy or procedure" to mean a course or principle of action
by the Louisiana Department of Health (LDH) or a managed care organization that may have
direct or indirect effect on a Medicaid enrollee or healthcare provider and shall include but
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HB NO. 434
not be limited to billing or claims submission and payment, medical management or
utilization review, case management, claims processing guidelines and edits, grievance and
appeals procedures and process, other guidelines or manuals containing pertinent
information related to operations and pre-processing claims, and core benefits and services.
Proposed law establishes a public notice requirement for any contract amendment proposed
by requiring LDH to publish, on a publicly accessible page of LDH's website, a copy of the
entire proposed contract amendment and to provide a public comment period of no less than
30 days; except where LDH finds imminent peril to public health, safety, or welfare in which
case they may immediately execute the proposed contract amendment upon publishing a
copy of the contract amendment and a written statement that details the reason for finding
that an imminent peril requires adoption of the executed amendment.
Proposed law establishes policies and procedure for adoption of policies which require LDH
to publish the proposed policy or procedure on a publicly accessible page of LDH's website
for a period of no less than 45 days for the purpose of soliciting public comment. LDH shall
determine the format; however, LDH shall include existing policy or procedure along with
proposed policy or procedure.
Proposed law provides that any policy or procedure proposed by a managed care
organization shall not be implemented unless approved by LDH in accordance with the law,
regulation, or a contract after the expiration of the public notice period. However, if LDH
finds that imminent peril requires immediate approval, LDH may implement the proposal
upon publishing a written statement that details its reasons for finding that imminent peril
requires adoption of the proposed policy or procedure and a copy of the proposed policy or
procedure.
Proposed law provides that proposed law shall not apply to any policy or procedure that is
promulgated in accordance with the Administrative Procedure Act or included in a duly
executed contract.
Proposed law prohibits LDH or a managed care organization from enforcing any policy or
procedure that is not adopted in compliance with this section.
Proposed law requires that any policy or procedure change made by a managed care
organization be submitted to LDH for approval within a given time frame of making the
change.
(Adds R.S. 46:460.51(15), 460.53, and 460.54)
Summary of Amendments Adopted by House
The Committee Amendments Proposed by House Committee on Health and Welfare to
the original bill:
1. Requires the Louisiana Department of Health to approve policies or procedures
proposed by a managed care organization in accordance with law, regulation, or
a contract after the expiration of the required public notice period.
2. Add the requirement that any policy or procedure change made by a managed
care organization be submitted to the Louisiana Department of Health for
approval within a given time frame for approval.
3. Make technical changes.
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