MS HB146

Managed care organizations (MCOs) under Mississippi Medicaid must use clear, widely accepted level of care guidelines for medical necessity determinations and all utilization management practices, including prior authorization, concurrent reviews, and retrospective reviews

Required guidelines include the Level of Care Utilization System (LOCUS), Child and Adolescent Level of Care Utilization System (CALOCUS), American Society of Addiction Medicine (ASAM) criteria, and Child and Adolescent Service Intensity Instrument (CASSI)

MCOs are prohibited from applying additional criteria that would deny care deemed medically necessary under these standardized guidelines and eight specified treatment principles

The eight guiding principles require treating underlying conditions (not just symptoms), coordinating care for co-occurring disorders, using least restrictive effective settings, erring toward higher levels of care when ambiguous, and considering unique needs of children and adolescents

Amends Section 43-13-117 of the Mississippi Code, with an effective date of July 1, 2026