LDH News
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Louisiana Medicaid Increased Physician Reimbursement Rates Beginning July 1, 2025
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.
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Hospital Services – Coverage of Gene Therapies for Sickle Cell Disease LAC 50:V.120
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.
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Nursing Facilities – Reimbursement Methodology LAC 50:VII.Chapter 200
Continues the June 30, 2025 Emergency Rule which amended 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.
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Professional Services Program – Reimbursement Methodology (LAC 50:IX.8305, 8505, 15113, 15133, and XIX.4334)
Adopts a new methodology for Medicaid managed care organization reimbursement and fee-for-service reimbursement rates to better align Medicaid rates to Medicare rates.
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Refugee Medical Assistance LAC 50:XXXI.Chapter 1
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.
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Hospital Services – Coverage of Gene Therapies for Sickle Cell Disease LAC 50:V.120
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.
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Nursing Facilities – Reimbursement Methodology LAC 50:VII.Chapter 200
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.
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Waiver Spend-Down Patient Liability Income (PLI) Update for Providers
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Home and Community-Based Services Waivers – Adult Day Health Care – Cost Reporting LAC 50:XXI.711
Amends the provisions governing adult day health care providers in order to clarify the cost report penalty language. This proposed Rule removes unnecessary language.
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Louisiana Expands Developmental Screening Support for Children through 2025 Initiative
The Developmental Screening Implementation Training and Support initiative equips healthcare providers with comprehensive resources to integrate the Louisiana Developmental Screening Guidelines (LDSG) into their practices.
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Louisiana Medicaid to launch consent-based verification pilot for income checks