RDCSB59 2709 4168
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)]
SB 59 Engrossed 2022 Regular Session Fred Mills
Present law provides for the Medicaid managed care program and the payment of healthcare
provider claims by Medicaid managed care organizations (MCOs).
Proposed law retains present law and prohibits MCOs, their contractors, assignees, and
agents from subjecting any Medicaid-enrolled healthcare provider to prepayment review
unless the prepayment review requirement is implemented directly by the La. Dept. of
Health in accordance with present law known as the Medical Assistance Programs Integrity
Law.
Proposed law provides that, for purposes of proposed law, "prepayment review" means any
action by an MCO or its contractor, assignee, agent, or entity acting on behalf of the MCO
which requires a healthcare provider to provide medical record documentation in
conjunction with, or after submission of, a claim for payment for medical services rendered,
but before the claim has been adjudicated by the MCO.
Proposed law provides that nothing therein shall prohibit an MCO from notifying the La.
Dept. of Health of healthcare providers suspected of committing fraud and abuse.
Proposed law provides that nothing therein shall prohibit the La. Dept. of Health from
requiring all MCOs to coordinate efforts to combat and prevent fraud and abuse pursuant to
any requirements ordered by the department in accordance with present law.
Proposed law stipulates that proposed law shall not apply to any dental coordinated care
network as defined in present law.
(Adds R.S. 46:460.76)
Summary of Amendments Adopted by House
The Committee Amendments Proposed by House Committee on Health and Welfare to
the engrossed bill:
1. Provide that nothing in proposed law shall prohibit an MCO from notifying the
La. Dept. of Health of healthcare providers suspected of committing fraud and
abuse.
2. Provide that nothing in proposed law shall prohibit the La. Dept. of Health from
requiring all MCOs to coordinate efforts to combat and prevent fraud and abuse
pursuant to any requirements ordered by the department in accordance with
present law.
3. Stipulate that proposed law shall not apply to any dental coordinated care
network as defined in present law.
4. Make technical changes.
Page 1 of 1