House Bill 715 Summary

• Requires managed care organizations operating under Mississippi Medicaid to use clear, widely-accepted level of care guidelines (such as LOCUS, CALOCUS, and ASAM) when determining medical necessity and conducting utilization management practices including prior authorizations and reviews.

• Prohibits managed care organizations from using additional criteria beyond the established guidelines that would deny care determined appropriate and medically necessary under those standards.

• Establishes eight principles that standards of care must incorporate, including treating underlying conditions (not just symptoms), coordinating treatment of co-occurring mental health and substance use disorders, and using multidimensional assessments to determine appropriate care levels.

• Requires managed care organizations to err on the side of caution by placing patients in higher levels of care when there is ambiguity about appropriate care level, and specifies that treatment duration should be based on individual patient needs with no specific limits.

• Takes effect July 1, 2021, and applies to all managed care entities contracting with Mississippi's Division of Medicaid.