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

HB 423 requires Mississippi Medicaid-managed care organizations (MCOs) to use specific, clear level-of-care guidelines when reviewing whether medical treatments are necessary. This applies to all MCOs operating under Mississippi's Medicaid program and directly affects Medicaid beneficiaries whose care requests are evaluated. The bill prohibits MCOs from adding extra criteria that would deny care deemed medically necessary under these established guidelines. It ensures MCO decisions align with widely accepted professional medical standards, aiming to prevent unnecessary denials of appropriate care.