Medicaid Rulemaking Actions 2025 Archive

Amends 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.

Contact Information: Tangela Womack, Bureau of Health Services Financing, P.O. Box 91030 Baton Rouge, LA 70821-9030

ICFs/IID Private Temporary Reimbursement Rate - Emergency Rule
ICFs/IID Private Temporary Reimbursement Rate - Notice of Intent
ICFs/IID Private Temporary Reimbursement Rate - Oversight

Amends the provisions governing reimbursement methodology in the Professional Services Program in order to allow coverage of physician-administered biosimilar drugs in Mary Bird Perkins Cancer Centers and establish the reimbursement methodology for their use.

Contact Information: Tangela Womack, Bureau of Health Services Financing, P. O. Box 91030 Baton Rouge, LA 70821-9030

Professional Services Program Reimbursement Methodology - Notice of Intent
Professional Services Program Reimbursement Methodology - Oversight

Amends the provisions governing the Community Choices Waiver to add a new priority group, specify the requirements for criminal history background checks and database checks for employees, update the Organized Health Care Delivery System (OHCDS) language to reflect the additional CCW services, revise the reimbursement language to agree with the wage floor requirements, and modify the language regarding direct support/service worker wages, other benefits, and workforce retention bonus payments to indicate that Louisiana Department of Health is no longer establishing the criteria.

Contact Information: Tangela Womack, Bureau of Health Services Financing, P.O. Box 91030 Baton Rouge, LA 70821-9030

Community Choices Waiver New Priority Group - Notice of Intent
Community Choices Waiver New Priority Group - Oversight

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.

Contact Information: Tangela Womack, Bureau of Health Services Financing, P.O. Box 91030 Baton Rouge, LA 70821-9030

ICF-IID Reimbursement Methodology - Notice of Intent
ICF-IID Reimbursement Methodology - Oversight

Allows persons who meet the Social Security disability criteria to seek the employment services, vocational rehabilitation services, and other support services needed to obtain, regain or maintain employment, and reduce their independence on cash benefit programs. Senate Concurrent Resolution 17 of the 2024 Regular Session of the Louisiana Legislature requests that the Department of Health increase eligibility requirements for the Medicaid Purchase Plan. This rulemaking action proposes to increase the income limit for this program from 100 percent to 200 percent of the federal poverty level (FPL), requires premiums for workers with income above 150 percent of FPL and increases the countable resources the worker can own from $10,000 to $25,000.

Contact Information: Tangela Womack, Bureau of Health Services Financing, P.O. Box 91030 Baton Rouge, LA 70821-9030

Medicaid Purchase Plan Eligibility - Notice of Intent
Medicaid Purchase Plan Eligibility - Oversight

Amends the provisions governing reimbursement for Federally Qualified Health Centers (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.

Contact Information: Tangela Womack, Bureau of Health Services Financing, P.O. Box 91030 Baton Rouge, LA 70821-9030

FQHC Alternative Payment Methodology - Notice of Intent
FQHC Alternative Payment Methodology - Oversight

Amends 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 (PDPM).  The PDPM shifts the focus from therapy-based payments to a more patient-centered approach that takes into account the individual needs and conditions of residents. This action is being taken to comply with federal requirements.

Contact Information: Tangela Womack, Bureau of Health Services Financing, P.O. Box 91030 Baton Rouge, LA 70821-9030

Nursing Facility Reimbursement Methodology - Emergency Rule
Nursing Facility Reimbursement Methodology - Notice of Intent
Nursing Facility Reimbursement Methodology - Oversight

Amends the provisions governing inpatient hospital services to allow reimbursement for gene therapies for sickle cell disease outside the per diem rate and paid based on the actual acquisition cost in order to take advantage of a federal rebate.

Contact Information: Tangela Womack, Bureau of Health Services Financing, P.O. Box 91030 Baton Rouge, LA 70821-9030

Sickle Cell Gene Therapy - Emergency Rule
Sickle Cell Gene Therapy - Notice of Intent
Sickle Cell Gene Therapy - Oversight

Adopts a new methodology for Medicaid managed care organization reimbursement and fee-for-service reimbursement rates to better align Medicaid rates to Medicare rates.

Contact Information: Tangela Womack, Bureau of Health Services Financing, P.O. Box 91030 Baton Rouge, LA 70821-9030

Professional Services Reimbursement Methodology - Emergency Rule
Professional Services Reimbursement Methodology - Notice of Intent
Professional Services Reimbursement Methodology - Oversight

Amends the provisions governing refugee medical assistance (RMA) to shorten the period that assistance is granted through the refugee medical assistance (RMA) program from one year to four months.

Contact Information: Tangela Womack, Bureau of Health Services Financing, P.O. Box 91030 Baton Rouge, LA 70821-9030

Refugee Medical Assistance - Emergency Rule
Refugee Medical Assistance - Notice of Intent
Refugee Medical Assistance - Oversight

Amends the provisions governing adult day health care providers in order to clarify the cost report penalty language. This proposed Rule removes unnecessary language.

Contact Information: Tangela Womack, Bureau of Health Services Financing, P.O. Box 91030 Baton Rouge, LA 70821-9030

ADHC Cost Reporting - Notice of Intent
ADHC Cost Reporting - Oversight

Amends the provisions governing eligibility for the Family Opportunity Act (FOA) Medicaid Program to establish continuous eligibility requirements and to prevent termination of Medicaid or CHIP eligibility due to non-payment of premiums for children under the age of 19 during a continuous eligibility period.

Contact Information: Tangela Womack, Bureau of Health Services Financing, P.O. Box 91030 Baton Rouge, LA 70821-9030

FOA Eligibility - Notice of Intent
FOA Eligibility - Oversight

Amends the provisions governing non-emergency medical transportation (NEMT) to allow an additional category of transportation services. Act 677 of the 2024 Regular Session of the Louisiana Legislature authorized the department to establish provisions for transportation network companies (TNC) to provide non-emergency medical transportation through the Medicaid program.

Contact Information: Tangela Womack, Bureau of Health Services Financing, P.O. Box 91030 Baton Rouge, LA 70821-9030

Medical Transportation Program NEMT - Notice of Intent
Medical Transportation Program NEMT - Oversight

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.

Contact Information: Tangela Womack, Bureau of Health Services Financing, P.O. Box 91030 Baton Rouge, LA 70821-9030

Targeted Case Management - Ventilator Care Coordination - Notice of Intent
Targeted Case Management - Ventilator Care Coordination - Oversight

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).

Contact Information: Tangela Womack, Bureau of Health Services Financing, P.O. Box 91030 Baton Rouge, LA 70821-9030

MCO Hospital and Practitioner Directed Payments - Notice of Intent
MCO Hospital and Practitioner Directed Payments - Oversight