MS HB1184

Requires managed care organizations in Mississippi's Medicaid program to use clear level of care guidelines (such as LOCUS, CALOCUS, and ASAM) that are consistent with widely accepted professional standards when determining medical necessity and conducting utilization management practices including prior authorization and reviews.

Prohibits managed care organizations from using additional criteria that would deny care determined appropriate and medically necessary under the specified guidelines and eight core principles of treatment.

Establishes eight principles for standards of care including: treating underlying conditions not just symptoms, coordinating treatment of co-occurring disorders, using the least intensive safe and effective level of care, erring on the side of caution when ambiguous, covering maintenance services, allowing treatment duration based on individual needs, considering unique needs of children and adolescents, and using multidimensional assessment.

Applies to all managed care programs, coordinated care organizations, health maintenance organizations, provider-sponsored health plans, and similar arrangements contracting with the Division of Medicaid.

Takes effect July 1, 2020.