MS HB317

Managed care organizations (MCOs) under Mississippi's Medicaid program must use clear, widely accepted professional standards of care guidelines when determining medical necessity, including LOCUS, CALOCUS, ASAM, and CASSI assessment tools

MCOs are prohibited from using additional criteria that would deny care deemed appropriate and medically necessary under the established level of care guidelines

Eight specific principles must be incorporated into standards of care, including treating underlying conditions (not just symptoms), coordinating treatment for co-occurring disorders, and using the least intensive/restrictive effective level of care

When ambiguity exists about appropriate care level, practitioners and insurers must err on the side of caution by placing patients in higher available levels of care

Treatment duration for mental health and substance use disorders must be based on individual patient needs with no specific time limits, and unique needs of children and adolescents must be considered in level of care decisions