MS HB425

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

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

The eight principles require treatment of underlying conditions, coordination of co-occurring disorders, least restrictive appropriate care, erring toward higher care levels when ambiguous, maintenance of functioning, individualized treatment duration, consideration of unique pediatric needs, and multidimensional assessment

Extends the repeal date of Section 43-13-117 from July 1, 2024 to July 1, 2025

Takes effect July 1, 2024