MS HB423

Requires managed care organizations under Mississippi Medicaid to use clear level of care guidelines (including LOCUS, CALOCUS, and ASAM standards) for determining medical necessity and conducting all utilization management practices.

Prohibits managed care organizations from using additional criteria that would deny care determined medically necessary under the specified level of care guidelines.

Mandates that level of care standards incorporate eight principles including treating underlying conditions, addressing co-occurring disorders, using the least intensive effective care, and using multidimensional assessment for decisions.

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

Takes effect July 1, 2025, and the amended section stands repealed July 1, 2028.