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Amends the provisions governing the reimbursement methodology for federally qualified health centers in order to implement a payment methodology to allow reimbursement for mammography screening and diagnosis services outside of the prospective payment system rate.
Adopts provisions governing an expedited licensing process and fees for healthcare facilities and providers licensed by the department in compliance with Act 324 of the 2018 Regular Session of the Louisiana Legislature.
Repeals and replaces the provisions governing the licensing standards for emergency medical transportation services in order to: 1) clarify and align these provisions with the corresponding legislative authorities governing emergency medical services; 2) ensure that the provisions are consistent with standard language used in other health care licensing regulations; and 3) promulgate the provisions in a clear and concise manner in the Louisiana Administrative Code in compliance with Act 789 of the 2012 Regular Session, Act 106 of the 2017 Regular Session, and Act 557 of the 2018 Regular Session of the Louisiana Legislature.
Amends the provisions governing The Optimal PDL $olution (TOP$) State Supplemental Rebate Agreement Program in order to include pharmacy utilization of managed care organizations (MCOs) that participate in the Healthy Louisiana Program and implement a single state managed preferred drug list to maximize supplemental rebates on MCO utilization.
Amends the provisions governing the administrative procedures for the administration of the Medical Assistance Program in order to adopt provisions which require current or prospective employees, contractors or subcontractors, within the Medicaid eligibility section that have access to federal tax information or criminal history record information, to submit to criminal history records checks.
Repeals and replaces the Rules governing inpatient hospital services in order to adopt an all patient refined diagnostic related group reimbursement methodology and to revise the remaining provisions for inpatient hospital services to ensure that these provisions are appropriately promulgated in a codified format for inclusion in the Louisiana Administrative Code.
Amends the provisions governing provider participation in the Home Health Program in order to remove the accreditation requirements for pharmacies that provide medical equipment, supplies and appliances, in compliance with federal regulations mandated by the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services.
Amends the Rule governing the dental benefits prepaid ambulatory health plan in order to adopt provisions for the independent process for the review of dental benefit plan manager provider claims payment determinations that are adverse to dental providers.
Continues the provisions of the June 30, 2018 Emergency Rule which amended the provisions governing disproportionate share hospital (DSH) payments for major medical centers in order to establish qualification criteria, and a DSH payment methodology, for large private hospitals located in the southwestern area of the state (LDH Region 4) which provide specialized intensive care burn units.
Amends the provisions governing the reimbursement methodology for FQHCs in order to implement a payment methodology to allow reimbursement for long-acting reversible contraceptive devices outside of the prospective payment system rates.
Continues the provisions of the July 1, 2018 Emergency Rule which amended the provisions governing healthcare services provider fees in order to calculate, levy and collect an assessment for each assessed hospital, with the exception of facilities prohibited from participating in the Medicare Program and to increase provider fees for emergency ground ambulance service providers.
Amends the provisions governing the Community Choices Waiver (CCW) in order to: 1) align the provisions governing target population, service definitions and provider qualifications with the waiver approved by the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services; 2) eliminate the non-medical transportation service; 3) amend the criteria for CCW priority offers to specify priority for individuals admitted to, or residing in, nursing facilities for whom Medicaid is the sole payer source; 4) change references to the minimum data set-home care to the International Resident Assessment Instrument (interRAI) assessment tool; and 5) allow OAAS to grant exceptions to waiver discharges for interruptions due qualifying circumstances.