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 Reengrossed 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 requirement governing the
administration of managed care organizations specific to billing guidelines, medical management
and utilization review guidelines, case management guidelines, 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 the Louisiana Dept. of Health (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 LDH has provided its express written approval to the managed care
organization 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.
The Committee Amendments Proposed by House Committee on Appropriations to the engrossed
bill:
1. Redefine the definition of "policy or procedure" to mean a requirement governing the
administration of managed care organizations specific to billing guidelines, medical
management and utilization review guidelines, case management guidelines, 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.
2. Delete provisions of proposed law that requires LDH 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 and instead requires
LDH to provide express written approval to the managed care organization of any policy
or procedure change made by a managed care organization after the expiration of the
public notice period.