MS HB187

Requires managed care organizations under Mississippi Medicaid to use clear level of care guidelines consistent with widely accepted professional standards (including LOCUS, CALOCUS, and ASAM) when determining medical necessity and utilization management practices.

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

Establishes eight principles that standards of care must incorporate, including treating underlying conditions, coordinating treatment of co-occurring disorders, using least intensive appropriate care levels, and erring toward higher care levels when ambiguous.

Applies to all managed care entities, coordinated care organizations, health maintenance organizations, and provider-sponsored health plans receiving capitated payments under the Division of Medicaid.

Takes effect July 1, 2023, and the entire Medicaid statute section stands repealed July 1, 2024.