Medicaid; require managed care organizations to use certain level of care guidelines in determining medical necessity.

HB 146 requires Mississippi's Medicaid managed care organizations (MCOs) to use clear, standardized guidelines based on widely accepted medical standards when determining if care is medically necessary. This directly affects Medicaid patients by preventing MCOs from denying care that professional guidelines would approve. The bill prohibits MCOs from adding extra criteria that would lead to denials of appropriate, necessary care. It mandates that all MCO utilization decisions align strictly with these specified guidelines, overseen by the Division of Medicaid.