GREEN SHEET REDIGEST
HB 434 2023 Regular Session McFarland
MEDICAID. Provides relative to the state medical assistance program.
DIGEST
Present law requires the La. Dept. of Health (LDH) to produce and submit to the Joint
Legislative Committee on the Budget and the House and Senate committees on health and
welfare a report entitled the "Healthy Louisiana Claims Report", which conforms with the
requirements of present law.
Proposed law requires the report to be submitted to the Joint Legislative Committee on the
Budget and the House and Senate committees on health and welfare on a quarterly basis and
otherwise retains the provisions of present law.
Present law requires LDH to conduct an independent review of claims submitted by
healthcare providers to Medicaid managed care organizations and establishes provisions for
such a review in accordance with the provisions of present law. Present law further provides
that the initial report shall include detailed findings and the defined measures to be reported
on a quarterly basis, as well as the data provided in present law. Present law includes any
dental Medicaid managed care organization contracted by LDH and separated by claim type.
Proposed law requires a quarterly report to include the data required in accordance with
present law by provider type and separately reported for both acute care and behavioral
health claims. Proposed law further removes dollar amount requirements from present law
and adds the following data requirements to present law:
(1)The total number of denied claims submitted to the managed care organization for
reconsideration of the claim denial, excluding a reconsideration conducted pursuant
to present law.
(2)The percentage of denied claims submitted to the managed care organization for
reconsideration of the claim denial, excluding a reconsideration conducted pursuant
to present law, that is overturned by the managed care organization.
(3)The number of denied claims submitted to the managed care organization for appeal
of the claim denial.
(4)The percentage of denied claims submitted to the managed care organization for
appeal of the claim denial that are overturned by the managed care organization.
(5)The total number of denied claims submitted to the managed care plan for arbitration
of the claim denial.
Present law requires the provision of certain data on claims submitted by behavioral health
providers based on the date of payment during the 2017 calendar year. Present law also
requires the provision of a narrative which present law establishes requirements therefor.
Proposed law removes the requirement of certain data on claims submitted by behavioral
health providers based on the date of payment during the 2017 calendar year. Proposed law
also removes the narrative requirement.
Present law requires the report to include certain data relating to encounters, including an
initial report and subsequent quarterly reports. Proposed law removes those requirements.
Proposed law further requires the quarterly report to include the total number of individuals
identified for case management categorized by all of the following:
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Prepared by Brandi Cannon. (1)The method of identification used by the managed care organization.
(2)The reason identified for case management.
(3)The La. Dept. of Health region.
Proposed law requires the quarterly reports to include certain information relating to
utilization management categorized by Medicaid managed care organizations.
Proposed law further requires the following data relating to utilization management
delineated by Medicaid managed care organizations:
(1)A list of all items and services that require prior authorization.
(2) The percentage of standard prior authorization requests that were approved,
categorized by type of service for all items and services subject to prior authorization.
(3) The percentage of standard prior authorization requests that was denied, categorized
by type of service for all items and services subject to prior authorization.
(4) The percentage of standard prior authorization requests that were approved after
appeal, categorized by type of service for all items and services subject to prior
authorization.
(5) The percentage of expedited prior authorization requests that were approved,
categorized by type of service for all items and services subject to prior authorization.
(6) The percentage of expedited prior authorization requests that was denied, categorized
by type of service for all items and services subject to prior authorization.
(7) The average and median time that elapsed between the submission of a request and
a determination by the managed care organization, for standard prior authorizations,
categorized by type of service for all items and services subject to prior authorization.
(8) The average and median time that elapsed between the submission of a request and
a decision by the managed care organization for expedited prior authorizations,
categorized by type of service for all items and services subject to prior authorization.
Effective Oct. 1, 2023.
(Amends R.S. 46:460.91)
Summary of Amendments Adopted by House
The Committee Amendments Proposed by House Committee on Health and Welfare to
the original bill:
1. Delete the requirement for tier assignment information to be included in the
quarterly report required by proposed law.
2. Specify that the total number of individuals who are accepted and enrolled in case
management services shall be included in the quarterly report.
3. Make technical corrections.
The House Floor Amendments to the engrossed bill:
1. Require all items and services subject to prior authorization to be categorized by
type of service prior to such authorization.
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Prepared by Brandi Cannon. 2. Change the effective date from effective upon signature of the governor to
effective on Oct. 1, 2023.
3. Make technical corrections.
Summary of Amendments Adopted by Senate
Committee Amendments Proposed by Senate Committee on Health and Welfare to the
reengrossed bill
1. Require LDH to report the total number of individuals enrolled in case
management who received specialized behavioral health services.
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Prepared by Brandi Cannon.