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 Original 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 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 without the express written approval to the managed care organization by LDH
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.
(Adds R.S. 46:460.51(15), 460.53, and 460.54)