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

Louisiana § 46:460.76.4

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

Text

§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.

Legislative History

Acts 2025, No. 440, §1.