HASBSB59 TYLERT 3993
SENATE SUMMARY OF HOUSE AMENDMENTS
SB 59 2022 Regular Session Fred Mills
KEYWORD AND SUMMARY AS RETURNED TO THE SENATE
MEDICAID. Provides relative to prepayment reviews conducted by Medicaid
managed care organizations. (8/1/22)
SUMMARY OF HOUSE AMENDMENTS TO THE SENATE BILL
1. Provides that nothing in proposed law prohibits a MCO from notifying the
department of suspected fraud and abuse.
2. Provides that nothing in proposed law prohibits the department from
requiring all MCOs to coordinate efforts to combat and prevent fraud and
abuse.
3. Exempts Medicaid dental coordinated care networks from proposed law.
4. Makes technical changes.
DIGEST OF THE SENATE BILL AS RETURNED TO THE SENATE
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)
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Christine Arbo Peck
Senate Counsel