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Repeals LAC 50:III.505 to align with recent legislative changes enacted through Act 427 of the 2025 Regular Session, which prohibits the department from accepting Medicaid eligibility determinations made by a Federally-Facilitated Exchange, including the Federally-Facilitated Marketplace.
Adopts provisions governing doula services in accordance with Act 228 of the 2025 Regular Session of the Louisiana Legislature. This proposed rule establishes coverage and reimbursement criteria for nonclinical maternal health services provided by registered doulas before, during, and after childbirth.
Amends the provisions governing targeted case management in order to add ventilator care coordination as a service. This proposed Rule establishes the requirements for beneficiaries to receive these services, the requirements for Medicaid-participating hospitals and providers, and clarifies the reimbursement rate for targeted case management services.
Amends the provisions governing Medicaid managed care organizations (MCOs) to allow practitioner and practitioner groups to participate in directed payments, in accordance with the preprint approved by Centers for Medicare and Medicaid Services (CMS).
Continues the provisions of the July 1, 2025 Emergency Rule (Louisiana Register, Volume 51, Number 7). These higher reimbursement rates may incentivize more providers to participate in Medicaid. Medicaid physician payment rates have historically been significantly lower than those of Medicare, often averaging around two-thirds of the Medicare rate.
Continues the July 1, 2025 Emergency Rule which adopted cell and gene therapy model that provides additional supplemental and federal rebates for gene therapies for sickle cell disease.
Continues the June 30, 2025 Emergency Rule which amended the provisions governing reimbursement for Nursing Facilities to revise the language and to replace resource utilization group resident classification system with the patient driven payment model.
Amends the provisions governing adult day health care providers in order to clarify the cost report penalty language. This proposed Rule removes unnecessary language.
Continues the provisions governing intermediate care facilities for persons with intellectual disabilities (ICF/IID) to extend the temporary rates for (ICFs/IID) that have a cooperative endeavor agreement with the Office for Citizens with Developmental Disabilities and have a high concentration of people who have intellectual developmental disabilities, significant behavioral health needs, and high risk behavior resulting in previous interface with the judicial system, and for whom no other private ICFs/IID provider is able to support. This action is being taken to promote the health and welfare of Medicaid recipients by ensuring that eligible ICFs/IID are able to maintain the current level of service.
Amends the provisions governing reimbursement methodology for intermediate care facilities for individuals with intellectual disabilities (ICFs/IID) in order to provide for a one-time lump sum payment in FY 2025 to all privately owned or operated (ICFs/IID) that billed Medicaid between August 1, 2024, and October 31, 2024, and are active and Medicaid certified at the time of payment. The total amount will be prorated among eligible facilities.
Amends the provisions governing intermediate care facilities for persons with intellectual disabilities (ICF/IID) to eliminate the expiration date on an increased per diem rate for ICFs/IID that downsized from over 100 beds to less than 35 beds prior to December 31, 2010, without the benefit of a cooperative endeavor agreement or transitional rate and that incurred excessive capital costs.
Amends the provisions governing reimbursement for FQHCs in order to establish an alternative payment methodology to pay an add-on of $50 per encounter in addition to the PPS rate on file for the date of service.