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During the claims cycle dated September 9, 2025, Gainwell Technologies identified a system error that prevented certain fee-for-service professional, outpatient hospital, and durable medical equipment (DME) claims from processing through the ClaimsXten (CXT) editing system.
The September 2025 Legislative Oversight Committee reports have been submitted to the respective legislative oversight committees in accordance with R.S. 49:968(D)(1)(b)(c) . Prior submissions are available in the archives.
The Louisiana Department of Health, Bureau of Health Services Financing has submitted Final Rules to the Office of the State Register for publication in the September 20, 2025 edition of the Louisiana Register in accordance with the provisions of the Administrative Procedure Act, R.S. 49:950 et seq.
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.
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).
Continues the provisions of the July 1, 2025 Emergency Rule (Louisiana Register, Volume 51, Number 7). These higher reimbursement rates may incentivize more providers to participate in Medicaid. Medicaid physician payment rates have historically been significantly lower than those of Medicare, often averaging around two-thirds of the Medicare rate.
Amends the provisions governing eligibility for the Family Opportunity Act 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.
Continues the provisions of the July 1, 2025 Emergency Rule (Louisiana Register, Volume 51, Number 7) which amended the provisions governing refugee medical assistance (RMA) to shorten the period that assistance is granted through the RMA program from one year to four months, and to outline the termination conditions for RMA services.
Effective July 1, 2025, Medicaid physician reimbursement rates increased to 85% of the March 2024 Region 99 Medicare rates for applicable services. Reimbursements at or above this threshold will remain the same.
Continues the July 1, 2025 Emergency Rule which adopted cell and gene therapy model that provides additional supplemental and federal rebates for gene therapies for sickle cell disease.