HB 565 Louisiana House · 2025 Regular Session

MEDICAID: Provides relative to third-party liability, claim adjudication, and timeliness of such within the state medical assistance program (EN SEE FISC NOTE GF EX)

HB 565 modifies how the state Medicaid program handles third-party liability claims, specifically setting deadlines for processing claims against other insurers or entities responsible for medical costs. It requires the state to implement new claim adjudication procedures under R.S. 46:460.76.3, beginning August 1, 2025. The bill directly affects Medicaid providers, insurers, and the state's medical assistance program by standardizing timeliness rules for claim resolution. Key provisions establish a clear timeline for adjudicating third-party claims to reduce delays in reimbursement. This is a procedural policy change focused on streamlining Medicaid claim processing within the state program.

Bill status signed all 5 stages cleared

Introduction

Apr 2025

Committee Review

May 2025

House Passage

Jun 2025

Senate Passage

Jun 2025

Signed into Law

Jun 2025

Introduced Apr 4, 2025 Signed Jun 11, 2025

Maddy AI version diff · 4 comparisons

What changed between versions

HB565 Original → HB565 Act 293 · 4 edits

MODERATE

This bill was amended to strengthen protections for Medicaid providers by strictly prohibiting managed care organizations from altering submitted claims or down-coding services, with specific exceptions for required audits. The changes also tighten notification timelines for third-party liability, requiring managed care organizations to inform the department within two business days instead of five, and significantly increase the financial penalties for violations from $25,000 to $100,000 for repeat offenders.

Scope change

The bill's scope was expanded to explicitly authorize statewide policies allowing post-payment reviews and audits, which were previously restricted, and the applicability of penalties was modified to include a higher threshold for multiple violations.

REQUIREMENT

Changed the deadline for managed care organizations to notify the department of third-party liability from five business days to two business days.

Added a specific prohibition against managed care organizations amending, modifying, or down-coding claims submitted by healthcare providers, with an exception for required post-payment audits.

Added authority for the department to promulgate rules allowing managed care organizations to conduct post-payment reviews and audits that would otherwise violate the strict claim submission rules.

ENFORCEMENT

Increased the minimum penalty for violating the third-party liability section from $25,000 to $100,000 if the managed care organization has committed multiple violations.

HB565 Enrolled → HB565 Original · 5 edits

MODERATE

The bill was renumbered and reclassified from an 'Enrolled' version to an 'Original' prefiling document, indicating it is in the early stages of the legislative process rather than being finalized. Substantively, the text of the bill was significantly reorganized and expanded to strengthen protections for Medicaid enrollees by clarifying that managed care organizations cannot deny claims solely because third-party liability exists. The new version adds specific requirements for notifying providers when payments are received from third parties and introduces a new mandate to notify the department when a Medicaid member is enrolled in Medicare Part C through an affiliated entity.

Scope change

The bill's scope was expanded to include specific notification requirements regarding Medicare Part C coverage held by affiliated entities and detailed rules for notifying providers of third-party payments.

TECHNICAL

The document header was changed from 'ENROLLED' to 'HLS 25RS-1004 ORIGINAL', indicating a shift from a final approved version to an original prefiling version.

REQUIREMENT

New requirements were added mandating that managed care organizations notify the department within two business days if a Medicaid member is enrolled in Medicare Part C coverage sold or administered by an affiliated entity.

New provisions require managed care organizations to provide written or electronic notification to healthcare providers within five business days after receiving payment from a liable third party, including copies of benefit explanations and policyholder details.

The prohibition on denying claims based on third-party liability was expanded to explicitly list that claims cannot be denied, pending, rejected, or recouped solely on this basis, with stricter rules on when such information must be available in the state system.

The bill now explicitly requires managed care organizations to notify the department within five business days if they identify other health insurance that is not reflected on the state's eligibility verification system.

Floor votes · Senate Jun 2, 2025 · House May 14, 2025

How they voted

36–0

Passed · 1 other

Total votes 37

Jun 2, 2025

D Democratic11

10 Yea 1

90% Yea

R Republican26

26 Yea

100% Yea

Vote distribution

All Yea All Nay Mixed No data

Full legislative history

Actions timeline

Total actions

Key actions

Committee

Jun 4, 2025

Lower · Passed

Read by title, roll called, yeas 93, nays 0. The Senate amendments, having received two-thirds vote of the elected members, were concurred in.

lower

Jun 2, 2025

Upper · Passed

The amended bill was read by title, passed by a vote of 38 yeas and 0 nays, and ordered returned to the House. Motion to reconsider tabled.

upper

May 29, 2025

Committee

Committee amendments read and adopted. Read by title and referred to the Legislative Bureau.

upper

May 28, 2025

Upper · Passed

Reported with amendments.

upper

May 14, 2025

Lower · Passed

Read third time by title, amended, roll called on final passage, yeas 97, nays 0. The bill, having received two-thirds vote of the elected members, was finally passed, title adopted, ordered to the Senate.

lower

May 8, 2025

Lower · Passed

Reported with amendments (12-0).

lower

Apr 14, 2025

Committee

Read by title, under the rules, referred to the Committee on Health and Welfare.

lower

Apr 4, 2025

Committee

Under the rules, provisionally referred to the Committee on Health and Welfare.

lower

1 primary · 0 co-sponsors