physicians be involved in all stages of development, review, and implementation of quality standards in the Medicaid program. 122.04 Health Care Quality Initiatives - Physician Clinical Performance Assessments REAFFIRMED The LSMS opposes the use of any clinical performance assessments completed by private or government payors from being introduced into evidence during any medical malpractice, state licensure, or hospital peer review proceeding. 123.03 Managed Care - Managed Care Plan’s Conditional Approval for Network REAFFIRMED The LSMS supports requiring managed care organizations (MCOs) operating in Louisiana to reimburse physicians for all care provided to patients covered by the MCO during the time between when the physician applies for credentialing with the MCO and the time the physician is finally approved for participation in the MCO panel. 123.05 Managed Care - Managed Care Plan Credentialing and Application Process REAFFIRMED The LSMS supports regulations which would require all managed care organizations to develop a uniform platform which would allow physician applicants the ability to immediately assess the status of his/her application for credentialing for an MCO panel. Fines should be implemented following 60 days after all documents are received that the managed care company is delayed in making a final decision on the physician’s application. MCOs seeking recredentialing of physicians should require only that physicians note or report any changes from the initial application or prior recertification. The LSMS opposes any law, policy, or contractual provision which seeks to require mandatory participation in the Medicaid program if the physician otherwise participates in commercial health insurance plans. 130.06 Indigent and Uninsured - Publicly Funded Healthcare Programs: Patient Protections and Rights REAFFIRMED 123.06 Managed Care – Commercial Insurance Tying REAFFIRMED The LSMS supports policies and initiatives which would require publicly funded programs providing healthcare services, to provide patients receiving services through these programs a schedule or list of the entitlements, benefits and patient rights including the right to select either a public or private sector physician for their health care. 143.05 Legislation and Regulation - LSMS Presence at Medicaid Budget Hearings REAFFIRMED The LSMS Department of Governmental Affairs will be present at any legislative committee hearing at which physician reimbursement will be discussed. The Department of Governmental Affairs will be present when the DHH budget is presented in committee so that reimbursement issues can be addressed. The LSMS Department of Governmental Affairs will work with the specialty societies to coordinate the attendance of physicians to provide testimony where issues related to Medicaid reimbursement are addressed.
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