SLS 22RS-208 ENGROSSED
2022 Regular Session
SENATE BILL NO. 59
BY SENATOR FRED MILLS AND REPRESENTATIVE BAGLEY
MEDICAID. Provides relative to prepayment reviews conducted by Medicaid managed care
organizations. (8/1/22)
1 AN ACT
2 To enact R.S. 46:460.76, relative to claim reviews conducted by Medicaid managed care
3 organizations; to provide for prepayment reviews; to provide for definitions; and to
4 provide for related matters.
5 Be it enacted by the Legislature of Louisiana:
6 Section 1. R.S. 46:460.76 is hereby enacted to read as follows:
7 ยง460.76. Prepayment review
8 A. A Medicaid managed care organization or a contractor, assignee,
9 agent, or entity acting on the behalf of a Medicaid managed care organization
10 shall be prohibited from requiring any enrolled provider to be subject to
11 prepayment review unless the requirement is implemented directly by the
12 Louisiana Department of Health and in accordance with the provisions of the
13 Medical Assistance Programs Integrity Law, R.S. 46:437.1 et seq.
14 B. For the purposes of this Section, "prepayment review" means any
15 action by a Medicaid managed care organization or a contractor, assignee,
16 agent, or entity acting on the behalf of a Medicaid managed care organization
17 requiring a healthcare provider to provide medical record documentation in
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. 59
SLS 22RS-208 ENGROSSED
1 conjunction with or after the submission of a claim for payment for medical
2 services rendered, but before the claim has been adjudicated by the Medicaid
3 managed care organization.
The original instrument and the following digest, which constitutes no part
of the legislative instrument, were prepared by Brandi Cannon.
DIGEST
SB 59 Engrossed 2022 Regular Session Fred Mills
Present law provides for the Louisiana Medicaid managed care program and the payment
of claims submitted by participating healthcare providers.
Proposed law retains present law and further provides that a Medicaid managed care
organization or its contractor, assignee, or agent is prohibited from requiring any enrolled
provider to be subject to prepayment review unless the requirement is implemented directly
by the La. Dept. of Health and in accordance with the provisions of the Medical Assistance
Programs Integrity Law.
Proposed law provides that "prepayment review" means requiring a healthcare provider to
provide medical record documentation in conjunction with, or after, the submission of a
claim for payment for medical services rendered but before the claim has been adjudicated
by the Medicaid managed care organization.
Effective August 1, 2022.
(Adds R.S. 46:460.76)
Page 2 of 2
Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.