Bill > HB423

This bill requires managed care organizations (MCOs) in Mississippi's Medicaid program to use specific level of care guidelines when determining medical necessity and conducting utilization management practices. The guidelines must be consistent with widely accepted professional standards of care, including the Level of Care Utilization System (LOCUS), Child and Adolescent Level of Care Utilization System (CALOCUS), and the American Society of Addiction Medicine (ASAM) tools. The bill introduces eight key principles that must be incorporated into these standards, such as treating underlying conditions, coordinating care for co-occurring disorders, providing treatment at the least intensive level that is safe and effective, and ensuring that treatment duration is based on individual patient needs. Importantly, the bill prohibits managed care organizations from using additional criteria that would result in denying care that would be considered medically necessary under these guidelines. The goal is to ensure a more comprehensive, patient-centered approach to determining medical necessity, particularly for mental health and substance use disorders, with special consideration for the unique needs of children and adolescents. The bill will take effect on July 1, 2025, giving managed care organizations time to implement these new guidelines and practices.

Agriculture and Natural Resources

https://billstatus.ls.state.ms.us/2025/pdf/history/HB/HB0423.xml