Louisiana § RS 46:460.76.4 - Prior authorization; suspension during state of emergency

§ RS 46:460.76.4. Prior authorization; suspension during state of emergency

            A. During a state of emergency declared by the governor, the Louisiana Department of Health may suspend utilization management requirements, including but not limited to prior authorization and concurrent review requirements for the Medical Assistance Program to ensure uninterrupted access to medically necessary healthcare services, including diagnostics, treatments, medications, and supportive services.

            B. Any Medicaid managed care organization, pharmacy benefit manager, or entity responsible for fee-for-service claims processing shall reimburse providers for medically necessary drugs, services, equipment, supplies, and therapies provided to Medicaid recipients during the emergency without requiring prior authorization. Any Medicaid managed care organization, pharmacy benefit manager, or entity responsible for fee-for-service claims processing shall reimburse any out-of-state provider that provided essential medical care to a Louisiana Medicaid recipient who evacuated out of state, whether voluntarily or involuntarily, without requiring prior authorization.

            C. The prior authorization suspension provided for in this Section shall only apply to Medicaid recipients who reside within the designated emergency area.

            D. The Medicaid managed care organizations shall notify Medicaid recipients of prior authorization suspensions, uninterrupted care access, and rights during emergencies. Notifications should be distributed through healthcare providers, community outreach, and online platforms to ensure all patients, especially vulnerable or displaced individuals, are aware of the provisions of this Section and can make informed decisions about their care.

            Acts 2025, No. 440, §1.