§ 46:460.74 — Prior authorization; criteria; notice to providers

Louisiana § 46:460.74

• Jurisdiction: Louisiana
• Title 46: Public Welfare and Assistance

Text

§460.74. Prior authorization; criteria; notice to providers
A. The prior authorization requirements of the department and each managed care
organization, including prior authorization requirements applicable in the Medicaid
pharmacy program, shall either be furnished to the healthcare provider within twenty-four
hours of a request for the requirements or posted in an easily searchable format on the
website of the respective managed care organization or the department. Information posted
in accordance with the requirements of this Section shall include the date of last review.
B. If the department or a managed care organization denies a prior authorization
request, then the department or managed care organization shall provide written notice of the
denial to the provider requesting the prior authorization within three business days of making
the decision. If the denial of the prior authorization by the department or managed care
organization is based upon an interpretation of a law, regulation, policy, procedure, or
medical criteria or guideline, then the notice shall contain either instructions for accessing
the applicable law, regulation, policy, procedure, or medical criteria or guideline in the public
domain or an actual copy of that law, regulation, policy, procedure, or medical criteria or
guideline.

Legislative History

Acts 2019, No. 330, §1.