State Plan Amendments - Archive

Louisiana’s Medicaid State Plan is an agreement between the state and the Federal government describing how Louisiana administers its Medicaid and children’s health insurance programs (CHIP). State Plan amendments (SPA) are requests from Louisiana to the Centers for Medicare & Medicaid Services (CMS) to make a change to the Louisiana Medicaid program’s policies or operational approach, make corrections, or updates to the state plan with new information.

Below are SPAs previously posted to the website for public comment.

Item Number State Plan Title Summary of Change Date Posted Public Comments Due By Document Links
SPA-2020-9

Transfer of Assets for Less than Fair Market Value

 

The purpose of the SPA is to align with current practices related to transfer of assets, in the Medicaid assistance program, for less than fair market value to: 1) begin the penalty date the first day of the month following the month of transfer; 2) impose penalty when the amount of the transfer is less than the monthly cost of nursing facility care; and 3) treat income as an asset. 

10/2/2020  11/1/2020  

Attachment 2.6A Supplement 9a, Pages 2-4   

Attachment 2.6A Supplement 9b, Page 2

SPA-2020-8

Nursing Facilities Reimbursement Methodology (Max. Sq. Ft.)

 

The purpose of the SPA is to amend the provisions governing the reimbursement methodology for nursing facilities in order to increase the allowable square footage for calculating payments when a Medicaid participating nursing facility has at least 15 percent of its licensed beds in private rooms.

10/2/2020  11/1/2020  

Attachment 4.19-D, Pages 7a-8

SPA-2020-7 

 

Hospice Services-Pediatric Concurrent Care

The purpose of this SPA is to amend the provisions governing hospice services provided concurrently with life-prolonging treatments to individuals under age 21 in order to update existing terminology and reflect current practices and to comply with federal requirements which allow for pediatric concurrent care.

9/8/2020  10/8/2020 

 

Attachment 3.1-A, Item 18, Page 8

Attachment 4.19-B, Item 18, Page 2

 
SPA-2020-6

Medical Care Advisory Committee

The purpose of the SPA is to remove Medical Care Advisory Committee (MCAC) procedural language at Attachment 1.4-A, Louisiana Medical Care. Louisiana remains compliant with the Medical Care Advisory Committee requirements at 42 CFR 431.12, in Section 1.4 of the State Plan.

7/30/20  8/29/20 

Attachment 1.4-A, Pages 1-3

 
SPA-2020-5

End Stage Renal Disease Facilities

The purpose of this SPA is to amend the provisions governing reimbursement for end stage renal disease (ESRD) facilities in order to allow contracted independent laboratories to bill the Medicaid program directly for the provision of covered non-routine laboratory services instead of receiving reimbursement from the ESRD facility.

 7/30/20 8/29/20 Attachment 4.19-B, Item 9, Pages 1a-1a(1) 
SPA-2020-4

Third Party Liability

The purpose of this SPA is to modify third party liability (TPL) rules related to special treatment of certain types of care and payment, and to allow for payment up to 100 days instead of 90 days after a claim is submitted for claims related to medical support enforcement.

7/16/20  8/15/20 Attachment 4.22, Item B, Pages 1-2
 SPA-2020-3

 

Inpatient Hospital Services Coverage Donor Breast Milk

The purpose of this SPA is to adopt provisions governing reimbursement outside of the inpatient hospital per diem for donor human breast milk provided to hospitalized premature newborns in order to ensure access to an effective treatment to reduce the incidence of severe complications.

6/3/20  7/3/20   

Attachment 3.1-A, Item 1, Page 46

Attachment 4.19-A, Item 1, Page 15

SPA-2020-2

Disproportionate Share Hospital Payments

The purpose of this SPA is to amend the provisions governing the definition of a public, non-rural community hospital, to include Thibodaux Regional Medical Center, formerly owned by a parish, city or other local government or instrumentality, after January 1, 2019.

2/4/2020 3/5/2020 Attachment 4.19-A, Item 1, Page 10k(2)
SPA-2020-1 

Pharmacy Benefits Management Program - Vaccine Administration and Reimbursement

The purpose of this SPA is to amend the provisions governing reimbursement in the Pharmacy Benefit Management Program in order to add vaccines for adult recipients as a pharmacy benefit to provide an alternative location for these recipients to receive necessary vaccinations and immunizations. 1/3/20  2/2/20  

Attachment 3.1-A, Item 6, Page 5 and Attachment 4.19-B, Item 6, Page 11

 SPA-2019-4 Managed Care Organizations Public Process

The purpose of this SPA is to amend the provisions governing public process for managed care organizations (MCOs) in order to remove language that refers to the utilization of rulemaking to satisfy public comment requirements and to add language that requires a 30-day public comment period for MCO contract amendments and a 45-day public comment period for policy or procedure changes unless the Louisiana Department of Health finds that imminent peril to the public’s health, safety, or welfare requires immediate approval.

12/23/19  12/30/19   Attachment 3.1-F, Page 3
SPA-2019-3

Pharmacy Benefits Management Program - Drug Utilization Review Program

The purpose of this SPA is to implement Medicaid drug utilization review (DUR) provisions, in compliance with the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act, that are designed to reduce opioid-related fraud, misuse and abuse, including:

 

  1. Opioid prescription claim reviews at the point of sale (POS) and retrospective reviews;
  2. Monitoring and management of antipsychotic medication in children; and
  3. Identification of processes to detect fraud and abuse.
9/13/19 9/20/19 Section 4.26, Pages 74-D and 74-E.
SPA-2019-2

Managed Care Organizations Open Enrollment Choice Period

The purpose of this SPA is to amend the provisions governing the enrollment choice period for Medicaid beneficiaries enrolled in a Managed Care Organization, from a 90-day period to a minimum of 30 days.

9/12/19 9/19/19 Attachment 3.1-F, Pages 11-12
SPA-2019-1 Medicaid Eligibility - Medicare Savings Programs

The purpose of this SPA is to amend the provisions governing financial eligibility in the Medical Assistance Program, in order to disregard all resources in eligibility determinations for all Medicare Savings Programs.

 8/23/19  9/22/19 Supplement 8b to Atachment 2.6-A, Page 2