RÉSUMÉ DIGEST
ACT 319 (HB 434) 2019 Regular Session Magee
Relative to Medicaid, new 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 processes, other
guidelines or manuals containing pertinent information related to operations and
pre-processing claims, and core benefits and services.
New 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.
New law establishes policies and procedures 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.
New 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.
New law provides that new 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.
New law prohibits LDH or a managed care organization from enforcing any policy or
procedure that is not adopted in compliance with this section.
New 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.
Effective August 1, 2019.
(Adds R.S. 46:460.51(15), 460.53, and 460.54)