Evidence record
Medicaid Managed Care Behavioral Health Services Denials in Louisiana
- Jurisdiction
- Louisiana
- Audit organization
- Office of Inspector General, U.S. Department of Health and Human Services
- Publication date
- March 2026
- Source record
- Original document linked
Findings
5
Recommendations
0
No formal recommendations were issued in this record.
Overall conclusion
Because LHCC revised its internal policy during our audit period to ensure that written notices of adverse determinations were sent to enrollees regardless of the enrollees' inpatient status, and because we did not identify any additional concerns after the effective date of this policy change, we are not making a formal recommendation.
Scope
Audit period January 1, 2023 through December 31, 2023. LHCC received 154,531 behavioral health service requests requiring prior authorization; 134,206 were approved and 20,325 denied. A simple random sample of 76 denied requests was reviewed to assess compliance with Federal and State requirements for prior authorization denials.
Findings (5)
Each finding has a stable link.
- F-1233
12 of the 76 sampled denied service requests did not meet administrative or procedural requirements.
- F-1234
11 of the sampled denials did not provide written notices of adverse determinations to enrollees.
- F-1235
1 of the sampled denials did not provide the written notice of adverse determination within the specified timeframe.
- F-1236
Causes of the errors included inadequate internal policies and procedures and training deficiencies that resulted in human error.
- F-1237
Based on the sample results, an estimated 3,209 prior authorization denials (15.8 percent) did not comply with Federal and State requirements.
Recommendations (0)
This record contains no formal recommendations.