RULEMAKING: Medicaid - Notices of Intent

November 14, 2017
Amends provisions governing managed care for physical and behavioral health in order to align the current Rule with the Code of Federal Regulations and the Louisiana Administrative Code which will: 1) revise timeframes for members to initiate state fair hearings and request appeals; 2) revise the timeframe for managed care organizations to resolve grievances; 3) update definitions to align with federal Rule changes; 4) revise record retention requirements; and 5) clarify reporting requirements.
November 14, 2017
Amends the provisions governing managed care for physical and behavioral health in order to adopt provisions for an independent review process for healthcare providers who have received an adverse determination on managed care organization claims payments.
November 14, 2017
Amends the provisions governing laboratory and radiology services to terminate coverage and reimbursement of proton beam radiation therapy for recipients 21 years of age and older.
November 14, 2017
Amends provisions governing children’s behavioral health services provided through the Home and Community-Based Behavioral Health Services Waiver in order to: 1) reflect the coordinated system of care contractor moving from a non-risk contract to a full-risk capitated contract; and 2) remove the requirement for the Office of Behavioral Health certification of providers.
November 14, 2017
Amends the provisions governing the facility need review (FNR) process to adopt provisions to include behavioral health services providers of psychosocial rehabilitation and/or community psychiatric support and treatment services in the FNR program..
November 14, 2017
Continues the provisions of the June 30, 2016 and February 20, 2017 Emergency Rules which adopted provisions to establish a qualification criteria and disproportionate share hospital payment methodology for major medical centers located in the central and northern areas of Louisiana.
November 14, 2017
Amends the provisions governing children’s behavioral health services in order to: 1) reflect the coordinated system of care contractor moving from a non-risk contract to a full-risk capitated contract; 2) remove the requirements for the Office Behavioral Health certification of providers and for prior approval of services; and 3) clarify the exclusion criteria for services rendered by institutes for mental disease.
November 14, 2017
Amends the provisions governing substance use disorders (SUD) services rendered to children and adults in order to: 1) reflect the coordinated system of care contractor moving from a non-risk contract to a full-risk capitated contract; 2) remove the requirements for the Office of Behavioral Health certification of providers and for prior approval of SUD services; 3) clarify the exclusion criteria for institutes for mental disease; and 4) clarify the requirements for residential addiction treatment facilities.
November 14, 2017
Amends the provisions governing the Healthy Louisiana and Coordinated System of Care (CSoC) Waiver in order to: 1) reflect the CSoC contractor moving from a non-risk contract to a full-risk capitated contract; 2) clarify the CSoC contractor procurement process; 3) remove the requirements for mandatory enrollment of CSoC participants and the Office of Behavioral Health certification of providers; and 4) clarify the grievance and appeals process.
October 11, 2017
Amends the provisions governing reimbursement for targeted case management services provided to participants in the Early and Periodic Screening, Diagnosis and Treatment program in order to adopt a payment methodology based on a flat monthly rate rather than 15-minute increments.