LA HB915

Amends R.S. 46:460.74 to replace "prior authorization" terminology with "utilization management" and establishes specific timeframes for managed care organizations to make service authorization determinations in Louisiana's Medicaid program.

Requires standard service authorizations within 5 business days, inpatient hospital authorizations within 2 calendar days, concurrent reviews within 1 calendar day, and expedited authorizations within 72 hours when an enrollee's health is at serious risk.

Reduces the deadline for written denial notices from 3 business days to 2 business days and requires denials to include instructions for accessing the applicable law, regulation, or medical criteria used.

Prohibits managed care organizations from denying claims based on lack of prior authorization if they fail to make determinations within the established timeframes, and bars them from retracting authorizations after services are provided unless provider misrepresentation occurred.

Requires managed care organizations to collect only necessary information for authorization, accept evidence-based information from providers, and complete retrospective review determinations within 30 calendar days.