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Amends the provisions governing Medicaid managed care organizations (MCOs) to update and align language in the administrative Rule with the preprints that are approved by the Department of Health and Human Services, Centers for Medicare and Medicaid Services that qualified hospitals with a balance owed as a result of reconciliation shall pay the amounts owed to the MCOs or the department.
Amends the provisions governing the Pharmacy Benefits Management Program in order to align the language in the Louisiana Administrative Code with the required changes requested by CMS to the State Plan relative to shortages of drugs not on the covered drug list, including drugs authorized for import by the Food and Drug Administration (FDA) that may be covered when deemed medically necessary during drug shortages identified by the FDA.
Amends the provisions governing the medical transportation program to establish guidelines for the administration and distribution of Elevated Level of Care (ELOC) services by non-emergency medical transportation (NEMT) vendors that meet the criteria to provide an elevated level of care service to Medicaid beneficiaries utilizing this service, and to clarify language regarding non-emergency medical ambulance transportation (NEAT) services.
Adopts provisions governing qualifying criteria and reimbursement methodology for high Medicaid utilization academic hospitals to increase payments for outpatient hospital services.
Adopts provisions governing qualifying criteria and reimbursement methodology for high Medicaid utilization academic hospitals to increase payments for inpatient hospital services.
Amends the provisions governing provider screening and enrollment in order to comply with U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services requirements to align the provisions governing out-of-state enrollment and single case agreements with the Medicaid Provider Enrollment Compendium, to codify provisions for informal hearings and appeal rights for provider enrollment denials and terminations, and to ensure that the administrative Rule is consistent with current practices.
Amends the provisions governing the Pharmacy Benefit Management Program in order to align the language in the Louisiana Administrative Code relative to drugs excluded from Medicaid coverage with the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services -approved State Plan amendment.
Repeals inpatient hospital services Rules which were promulgated prior to implementation of the Louisiana Administrative Code (LAC) codification system and amends the provisions governing inpatient hospital services in order to promulgate the criteria to qualify for reimbursement as a distinct part psychiatric unit in a codified format in the LAC and add qualifying criteria for rehabilitation, long-term, and freestanding hospitals.
Amends the provisions governing children’s and adult mental health services to expand the mental health professionals eligible to provide therapeutic services to include provisionally licensed professional counselors, provisionally licensed marriage and family therapists, and licensed master social workers.
Amends the provisions governing the Community Choices Waiver to update the individuals approved to be personal assistance service workers and monitored in-home caring principal caregivers, permit monitored in-home caregiving participants to receive adult day health care services simultaneously, and add financial management services as a new service when participants choose the self-direction option in order to align the administrative Rule with the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services approved waiver amendment.
Amends the provisions governing the Program of All Inclusive Care for the Elderly (PACE) in order to require that a PACE organization/provider have a personal care attendant (PCA) home and community-based services license in addition to the required adult day health care license if the organization/provider does not contract with a PCA agency, and updates language in order to reflect current practices and terminology.
Amends the provisions governing the reimbursement methodology for ambulatory surgical centers (ASCs) in order to allow qualified ASCs to bill for services provided to Medicaid beneficiaries at the outpatient hospital rate and be reimbursed on the current Louisiana State University enhanced fee schedule.