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HB786 • 2026

MEDICAID MANAGED CARE: Prohibits certain processes used in healthcare provider claim payments

MEDICAID MANAGED CARE: Prohibits certain processes used in healthcare provider claim payments

Healthcare
Passed Legislature

This bill passed both chambers and reached final enrollment, even if later executive action is not shown here.

Sponsor
Peter Egan
Last action
2026-05-26
Official status
Sent to Governor
Effective date
Not listed

Plain English Breakdown

The official source material does not provide information on penalties for violating the prohibition or how this change will affect existing contracts, leaving these points uncertain.

Medicaid Managed Care: No Extrapolation for Claim Payments

This bill stops managed care organizations from using extrapolation to audit healthcare providers' claims in Medicaid.

What This Bill Does

  • Defines 'extrapolation' as a mathematical process used by managed care organizations to estimate claim results without reviewing all claims.
  • Prohibits managed care organizations from using extrapolation when auditing healthcare providers for Medicaid payments.
  • Specifies that any additional payment or refund due must be based on actual overpayment or underpayment, not on extrapolation.

Who It Names or Affects

  • Managed care organizations
  • Healthcare providers participating in Medicaid

Terms To Know

extrapolation
A math process used by managed care organizations to estimate claim results without reviewing all claims.

Limits and Unknowns

  • The bill does not specify what happens if managed care organizations violate the prohibition on extrapolation.
  • It is unclear how this change will affect existing contracts between healthcare providers and managed care organizations.

Amendments

These notes stay tied to the official amendment files and metadata from the legislature.

Adopted

Plain English: HFAHB786 4921 4270 FOR OFFICE USE ONLY HOUSE FLOOR AMENDMENTS 2026 Regular Session Amendments proposed by Representative Egan to Engrossed House Bill No.

  • HFAHB786 4921 4270 FOR OFFICE USE ONLY HOUSE FLOOR AMENDMENTS 2026 Regular Session Amendments proposed by Representative Egan to Engrossed House Bill No.
  • 786 by Representative Egan 1 AMENDMENT NO.
  • 1 2 On page 2, line 2, after "department" and before "the" change "of" to "or" Page 1 of 1 CODING: Words in struck through type are deletions from existing law; words underscored are additions.
Filed

Plain English: HFAHB786 4921 4042 FOR OFFICE USE ONLY HOUSE FLOOR AMENDMENTS 2026 Regular Session Amendments proposed by Representative Egan to Engrossed House Bill No.

  • HFAHB786 4921 4042 FOR OFFICE USE ONLY HOUSE FLOOR AMENDMENTS 2026 Regular Session Amendments proposed by Representative Egan to Engrossed House Bill No.
  • 786 by Representative Egan 1 AMENDMENT NO.
  • 1 2 On page 2, delete line 2 and insert the following: 3 "otherwise prohibit the Louisiana Department of Justice from using" Page 1 of 1 CODING: Words in struck through type are deletions from existing law; words underscored are additions.
Adopted

Plain English: HCAHB786 4921 3870 HOUSE COMMITTEE AMENDMENTS 2026 Regular Session Amendments proposed by House Committee on Health and Welfare to Original House Bill No.

  • HCAHB786 4921 3870 HOUSE COMMITTEE AMENDMENTS 2026 Regular Session Amendments proposed by House Committee on Health and Welfare to Original House Bill No.
  • 786 by Representative Egan 1 AMENDMENT NO.
  • 1 2 On page 1, after line 19, insert the following: 3 "(3) Nothing in this Subsection shall be interpreted or construed to prevent 4 or otherwise prohibit the department of the Louisiana Department of Justice of using 5 extrapolation to complete an audit of a healthcare provider pursuant to existing state 6 and federal law and regulation." Page 1 of 1 CODING: Words in struck through type are deletions from existing law; words underscored are additions.

Bill History

  1. 2026-05-26 H

    Sent to the Governor for executive approval.

  2. 2026-05-25 S

    Signed by the President of the Senate.

  3. 2026-05-25 H

    Enrolled and signed by the Speaker of the House.

  4. 2026-05-25 H

    Received from the Senate without amendments.

  5. 2026-05-21 S

    Rules suspended. Read by title, passed by a vote of 35 yeas and 0 nays, and ordered returned to the House. Motion to reconsider tabled.

  6. 2026-05-18 S

    Reported without Legislative Bureau amendments. Read by title and passed to third reading and final passage.

  7. 2026-05-14 S

    Read by title and referred to the Legislative Bureau.

  8. 2026-05-13 S

    Reported favorably.

  9. 2026-04-28 S

    Read second time by title and referred to the Committee on Health and Welfare.

  10. 2026-04-27 S

    Received in the Senate. Read first time by title and placed on the Calendar for a second reading.

  11. 2026-04-22 H

    Read third time by title, amended, roll called on final passage, yeas 95, nays 0. Finally passed, title adopted, ordered to the Senate.

  12. 2026-04-21 H

    Scheduled for floor debate on 04/22/2026.

  13. 2026-04-16 H

    Read by title, amended, ordered engrossed, passed to 3rd reading.

  14. 2026-04-15 H

    Reported with amendments (13-0).

  15. 2026-03-09 H

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

  16. 2026-02-27 H

    First appeared in the Interim Calendar on 2/27/2026.

  17. 2026-02-27 H

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

  18. 2026-02-27 H

    Prefiled.

Official Summary Text

MEDICAID MANAGED CARE: Prohibits certain processes used in healthcare provider claim payments

Current Bill Text

Read the full stored bill text 
ENROLLED
2026 Regular Session
HOUSE BILL NO. 786
BY REPRESENTATIVE EGAN
1 AN ACT
2 To amend and reenact R.S. 46:460.75(C) through (E) and to enact R.S. 46:460.75(F),
3 relative to the state medical assistance program; to provide for provider claim
4 payments; to provide for definitions; to prohibit the use of extrapolation; and to
5 provide for related matters.
6 Be it enacted by the Legislature of Louisiana:
7 Section 1. R.S. 46:460.75 (C) through (E) are hereby amended and reenacted and
8 R.S. 46:460.75(F) is hereby enacted to read as follows:
9 §460.75. Provider claim payment and information protection
10 * * *
11 C.(1) For the purposes of this Section, "extrapolation" means a mathematical
12 process or technique used by a managed care organization in the audit of a healthcare
13 provider to estimate audit results or findings for a larger batch or group of claims not
14 reviewed by the managed care organization.
15 (2) A managed care organization shall be strictly prohibited from using
16 extrapolation to complete an audit of a healthcare provider. Any additional payment
17 due to a healthcare provider or any refund or recoupment due to the managed care
18 organization shall be based on the actual overpayment or underpayment and shall not
19 be based on extrapolation.
20 (3) Nothing in this Subsection shall be interpreted or construed to prevent or
21 otherwise prohibit the department or the Louisiana Department of Justice of using
22 extrapolation to complete an audit of a healthcare provider pursuant to existing state
23 and federal law and regulation.
Page 1 of 2
CODING: Words in struck through type are deletions from existing law; words underscored
are additions.
HB NO. 786 ENROLLED
1 C. D. The provisions of this Section shall not be waived by contract, and any
2 contractual clause in conflict with the provisions of this Section or that purports to
3 waive any requirements of this Section is void.
4 D. E. If the managed care organization, its contracted vendor, or agent
5 violates any provision of this Section, the department shall impose penalties on the
6 managed care organization in accordance with contract provisions or rules and
7 regulations promulgated pursuant to the Administrative Procedure Act, except that
8 penalties shall be imposed without the necessity of the department having to issue
9 any prior notice of corrective action.
10 E. F. As used in this Section, "electronic funds transfer" means an electronic
11 funds transfer through the federal Health Insurance Portability and Accountability
12 Act of 1996, P.L. 104-191, standard automated clearinghouse network.
SPEAKER OF THE HOUSE OF REPRESENTATIVES
PRESIDENT OF THE SENATE
GOVERNOR OF THE STATE OF LOUISIANA
APPROVED:
Page 2 of 2
CODING: Words in struck through type are deletions from existing law; words underscored
are additions.