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November 08, 2019
Home and Community-Based Behavioral Health Services Waiver – Coordinated System of Care Discharge Criteria LAC 50:XXXIII.8101 and 8103

Amends the provisions governing the home and community-based behavioral health services waiver to specify discharge criteria for the Coordinated System of Care (CSoC) program which aligns with federal regulations and current practices, since the current administrative Rule does not address the authority to discharge participants who no longer meet CSoC waiver eligibility requirements.
November 08, 2019
Federally Qualified Health Centers - Reimbursement Methodology - Mammography Separate Payments LAC 50:XI.10703

Amends the reimbursement methodology for federally qualified health centers in order to repeal the provisions of the December 20, 2018 Rule, which allowed a separate payment outside of the prospective payment system rate for mammography screening and diagnosis services, due to the disapproval of the corresponding State Plan Amendment by the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services.
October 10, 2019
Behavioral Health Services – Treatment for Opioid Use Disorder in Opioid Treatment Programs LAC 50:XXXIII.Chapters 151-157

Adopts provisions governing medication-assisted opioid use disorder (OUD) treatment in Opioid Treatment Programs, for Medicaid-eligible recipients ages 18 and over, diagnosed with OUD.
October 10, 2019
Intermediate Care Facilities for Persons with Intellectual Disabilities – Dedicated Program Funding Pool Payments LAC 50:VII.32917

Adopts provisions governing reimbursement to non-state intermediate care facilities for individuals with intellectual disabilities to allow one-time, lump sum payments from the dedicated program funding pool in compliance with Act 50 of the 2019 Regular Session of the Louisiana Legislature.
October 10, 2019
Intermediate Care Facilities for Persons with Intellectual Disabilities – Reimbursement Methodology – Direct Care Floor LAC 50:VII.32901

Amends the provisions governing reimbursement for intermediate care facilities for individuals with intellectual disabilities in order to correct an invalid citation in the direct care floor language and ensure that these provisions are appropriately promulgated in the Louisiana Administrative Code.
October 10, 2019
Medicaid Eligibility – Modified Adjusted Gross Income Groups LAC 50:III.10307

Amends the provisions governing Medicaid eligibility for modified adjusted gross income (MAGI) groups and income factors in order to clarify and align these provisions with current Federal regulations relative to the calculation of household income.
October 10, 2019
Medication Attendant Certified – Licensing Standards

Amends the provisions governing the licensing of individuals certified by the department to administer medications to nursing facility residents, medication attendants certified (MACs), in order to revise and update the MAC training and certification requirements.
October 10, 2019
Pharmacy Benefits Management Program – Dispense as Written Electronic Prescribing LAC 50:XXIX.Chapters 1,5,7,9 and 11

Amends the provisions governing the Pharmacy Benefits Management Program in order to allow notation of the medical necessity of brand drugs using electronic prescriptions, to allow the state to pursue outcomes-based agreements with manufacturers, and to align the provisions with the current Medicaid State Plan.
September 11, 2019
Inpatient Hospital Services – Non-Rural, Non-State Hospitals – Reimbursement Rate Adjustment LAC 50:V.Chapters 5 and 9

Amends the provisions governing the reimbursement methodology for inpatient hospital services in order to adjust the reimbursement rates in compliance with House Concurrent Resolution 5 of the 2019 Regular Session of the Louisiana Legislature.
September 11, 2019
Outpatient Hospital Services - Non-Rural, Non-State Hospitals - Reimbursement Rate Adjustment LAC 50:V.Chapters 53-61

Amends the provisions governing the reimbursement methodology for outpatient hospital services in order to adjust the reimbursement rates in compliance with House Concurrent Resolution 5 of the 2019 Regular Session of the Louisiana Legislature.
September 11, 2019
Medicaid Eligibility - Medicare Savings Programs LAC 50:III.10703 and 10705

Amends the provisions governing financial eligibility in the Medical Assistance Program in order to disregard all resources of aged, blind and disabled individuals in all MSP eligibility determinations.
September 11, 2019
Managed Care for Physical and Behavioral Health – Reimbursement Methodology – Kick and Lump Sum Payments LAC 50:I.3509

Amends the provisions governing managed care organizations (MCOs) reimbursement to allow for expansion of the current kick payment methodology to include reimbursements for specific care events, services, and treatments in addition to obstetrical deliveries and for reimbursement of the MCO monthly capitation and kick payments in the aggregate on a lump sum basis when administratively necessary.

LDH News

Home and Community-Based Behavioral Health Services Waiver – Coordinated System of Care Discharge Criteria LAC 50:XXXIII.8101 and 8103

Federally Qualified Health Centers - Reimbursement Methodology - Mammography Separate Payments LAC 50:XI.10703

Behavioral Health Services – Treatment for Opioid Use Disorder in Opioid Treatment Programs LAC 50:XXXIII.Chapters 151-157

Intermediate Care Facilities for Persons with Intellectual Disabilities – Dedicated Program Funding Pool Payments LAC 50:VII.32917

Intermediate Care Facilities for Persons with Intellectual Disabilities – Reimbursement Methodology – Direct Care Floor LAC 50:VII.32901

Medicaid Eligibility – Modified Adjusted Gross Income Groups LAC 50:III.10307

Medication Attendant Certified – Licensing Standards

Pharmacy Benefits Management Program – Dispense as Written Electronic Prescribing LAC 50:XXIX.Chapters 1,5,7,9 and 11

Inpatient Hospital Services – Non-Rural, Non-State Hospitals – Reimbursement Rate Adjustment LAC 50:V.Chapters 5 and 9

Outpatient Hospital Services - Non-Rural, Non-State Hospitals - Reimbursement Rate Adjustment LAC 50:V.Chapters 53-61

Medicaid Eligibility - Medicare Savings Programs LAC 50:III.10703 and 10705

Managed Care for Physical and Behavioral Health – Reimbursement Methodology – Kick and Lump Sum Payments LAC 50:I.3509

Surgeon General Evelyn Griffin, MD

Secretary Bruce D. Greenstein