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Continues the provisions of the September 16, 2024 Emergency Rule, which establishes a reimbursement methodology to ensure that other rural hospitals remain financially viable, so that the access to medical care provided to Medicaid beneficiaries in their communities will continue to be available and will improve in the future.
Amends the provisions governing the Community Choices Waiver to add a new priority group, specify the requirements for criminal history background checks and database checks for employees, update the Organized Health Care Delivery System (OHCDS) language to reflect the additional CCW services, revise the reimbursement language to agree with the wage floor requirements, and modify the language regarding direct support/service worker wages, other benefits, and workforce retention bonus payments to indicate that Louisiana Department of Health is no longer establishing the criteria.
Amends the provisions governing Adult Day Health Care providers in order to incorporate language which allows the department to impose a penalty fee for each month a claim or report is filed or submitted beyond the close of the reporting period.
Amends the provisions governing reimbursement methodology in the Professional Services Program in order to allow coverage of physician-administered biosimilar drugs in Mary Bird Perkins Cancer Centers and establish the reimbursement methodology for their use.
Amends the provisions governing the Pharmacy Benefits Management Program to update copay tier payment schedule to align with the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services recommended guidelines.
Amends the provisions governing long term personal care services (LT-PCS) to update language pertaining to rights and responsibilities, cost reporting requirements, and add new language for a rate methodology to align current policies and procedures under the home and community based services waivers with the Louisiana Administrative Code.
Amends the provisions governing the supports waiver services to add assistive technology with remote features to specialized medical equipment, place service limits on assistive technology with remote features and incontinence supplies, include additional requirements for day habilitation and prevocational services providers and require that community life engagement providers must possess a valid adult day care license and provide day habilitation services.
Amends the provisions governing Support Coordination Standards for Participation to align the administrative Rule with current policy and procedures under the Home and Community-Based Services (HCBS) Waivers relative to general provisions, administration and organization, provider responsibilities, and to establish cost reporting requirements for support coordination agencies providing waiver services.
Amends the provisions governing Residential Options Waiver (ROW) services to clarify the tiered waiver approach in OCDD waivers and add new services including technology supports with remote features, incontinence supplies, the Person Emergency Response System, Community Life Engagement, and self-directed services as well as dismissal from self-direction.
Amends the provisions governing the Pharmacy Benefits Management Program in order to align the language in the Louisiana Administrative Code relative to vaccine administration and fees for Medicaid coverage with the CMS-approved State Plan amendment..
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.