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Continues the provisions of the May 15, 2023 Emergency Rule which amends the provisions governing directed payments in order to reserve the right to discontinue interim directed payments to any hospital whose projected recoupment is greater than 50 percent or who discontinues operations during or prior to the directed payment contract period.
Adopts provisions governing medically necessary inpatient services furnished to Louisiana Medicaid beneficiaries by out-of-state hospitals in order to align the reimbursement rates for those services with current in-state inpatient per diem rates for like hospitals/services.
Adopts provisions establishing the standards for participation for fiscal employer agents that provide financial management services for self-directed home and community-based waiver services administered by the Office of Aging and Adult Services and the Office for Citizens with Developmental Disabilities.
Continues the provisions of the July 1, 2023 Emergency Rule which amended the provisions governing provider fees for emergency ground ambulance services in order to ensure that the language in the administrative rule reflects the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services requirement that reimbursement for these services transition from the Full Medicaid Pricing program to an approved federal supplemental payment program.
Amends the provisions governing the Direct Service Worker (DSW) Registry to ensure that prior to hiring a DSW or trainee, the licensed and/or certified health care provider ensures that the individuals are at least 18 years of age or that the individuals are at least 16 years of age and have received an age restriction exception from the Office for Citizens with Developmental Disabilities or the Office of Aging and Adult Services.
Amends the provisions governing methods of payment in the Pharmacy Benefits Management Program in order to: 1) change the reimbursement methodology for clotting factor products to a state generated actual acquisition cost ingredient cost and a unit based professional dispensing fee; and 2) limit clotting factor products to pharmacy claims only, in compliance with U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services requirements.
Amends the provisions governing eligibility for the Medical Assistance Program in order to align the exclusions to the 12-month continuous eligibility coverage period for children in the administrative Rule with the Medicaid and Children’s Health Insurance Program (CHIP) State Plans approved by the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services.
Amends LAC 50:V.Chapter 9 to remove obsolete non-rural, non-state hospital provisions and to repeal uncodified inpatient hospital services rules governing Medicaid transplant services and well baby care reimbursement in order to promulgate these provisions in a codified format for inclusion in the Louisiana Administrative Code.
Continues the provisions of the April 3, 2023 Emergency Rule which amended the provisions governing reimbursement in the Home Health program to increase the rates for all home health services and base reimbursement on the Louisiana Medicaid fee schedule in order to align the reimbursement methodology with current practice.
Amends the provisions governing school-based health services in the Early and Periodic, Screening and Diagnosis and Treatment Program in order to reflect the current reimbursement methodology, include criteria for determining medical necessity, and modify service exclusion to match the 2019 program expansion provisions which will align the administrative Rule with the corresponding State Plan amendment approved by the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services.
Amends the provisions governing financial eligibility for Medicaid in order to disregard resources accumulated from March 18, 2020 through March 31, 2023 that, but for the continuous enrollment provision at Section 60008(b)(3) of the Families First Coronavirus Act, would have been paid toward the cost of a beneficiary’s home and community-based services waiver or institutional services.
Amends the provisions governing Medicaid eligibility groups and programs in order to remove the requirement that an applicant be ineligible for other Medicaid services before being considered for the Act 421 Children’s Medicaid Option and to revise language regarding level of care.