SLS 20RS-465 ORIGINAL
2020 Regular Session
SENATE BILL NO. 281
BY SENATOR LUNEAU
HEALTH DEPARTMENT. Provides relative to contracts with Medicaid managed care
organizations. (8/1/20)
1 AN ACT
2 To enact R.S. 39:1648.1, relative to contracts with Medicaid managed care organizations;
3 to provide for minimum requirements; to provide for staff requirements; to provide
4 for healthcare provider audits; to provide for frequency of updating provider rosters;
5 and to provide for related matters.
6 Be it enacted by the Legislature of Louisiana:
7 Section 1. R.S. 39:1648.1 is hereby enacted to read as follows:
8 ยง1648.1. Medicaid contracts; minimum requirements
9 A. Contracts entered into by the Louisiana Department of Health with
10 any Medicaid managed care organization shall include the following minimum
11 requirements:
12 (1) Individuals who are employed by the managed care organization to
13 make prior authorization determinations, supervise prior authorization staff,
14 conduct clinical reviews, or perform audits shall be domiciled in Louisiana.
15 (2)(a) Audits shall be conducted on providers in the managed care
16 organizations network at least once, but no more than twice in a fiscal year to
17 ensure compliance with program standards. More frequent audits may be
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. 281
SLS 20RS-465 ORIGINAL
1 performed if the provider does not score at least eighty percent on the audit or
2 if the provider does not complete a corrective action plan. A corrective action
3 plan shall be required of every provider that does not score at least eighty
4 percent on the audit.
5 (b) A managed care organization may initiate claim payment
6 recoupment when a provider fails to comply with a corrective action plan after
7 a subsequent audit and shall initiate claim payment recoupment immediately
8 for claims in which fraud, waste, or abuse are identified in the audit.
9 (3) Standardized provider rosters shall be updated within seven days of
10 receipt.
11 B. No Medicaid managed care organization contract shall be executed
12 without the inclusion of the minimum requirements set forth in this Section.
13 Any existing contract entered into prior to August 1, 2020, shall be amended to
14 include the minimum requirements set forth in this Section.
15 C. The department shall enforce monetary penalties against any
16 Medicaid managed care organization that violates the contractual provision
17 provided for in this Section.
The original instrument and the following digest, which constitutes no part
of the legislative instrument, were prepared by Christine Arbo Peck.
DIGEST
SB 281 Original 2020 Regular Session Luneau
Proposed law provides for minimum requirements for contracts entered into by the La. Dept.
of Health with any Medicaid managed care organization, including staff domicile
requirements, for employees that perform certain functions, minimum audit standards, and
publication of a standardized provider rosters updated within seven days of receipt.
Proposed law provides that no Medicaid managed care organization contract shall be
executed without inclusion of the minimum requirements and that any existing contract
entered into prior to August 1, 2020, shall be amended to include the minimum
requirements.
Proposed law provides that the department shall enforce monetary penalties against any
Medicaid managed care organization that violates minimum contractual requirements.
Effective August 1, 2020.
(Adds R.S. 39:1648.1)
Page 2 of 2
Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.