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Amends the provisions governing the programmatic allocation of waiver opportunities in the Community Choices Waiver in order to give priority to individuals not receiving any other Medicaid home and community-based service.
Repeals the provisions of Title 48, Part I, Chapter 49 of the Louisiana Administrative Code governing case management licensing standards and replaces them with provisions governing the licensing of support coordination providers to ensure that these provisions are consistent with other health care licensing requirements and are promulgated in a clear and concise manner.
Amends the provisions governing reimbursement in the Pharmacy Benefits Management Program in order to: 1) reinstate the federal upper payment limits provisions that were erroneously repealed in the Notice of Intent published in the January 20, 2019 edition of the Louisiana Register; 2) align the reimbursement methodology for physician-administered drugs in a physician office setting with the corresponding CMS-approved State Plan Amendment; and 3) ensure that these provisions are appropriately promulgated in the Louisiana Administrative Code.
Amends the provisions governing the Direct Service Worker (DSW) Registry in order to 1) provide a process for direct service workers who have been placed on the DSW Registry with a negative finding of neglect to a client to request removal, under certain conditions, and to provide for appeal opportunities if the reinstatement request is denied; and 2) clarify and ensure that the provisions for the DSW Registry are promulgated in a clear and concise manner.
Amends the provisions governing reimbursement in the Pharmacy Benefits Management Program in order to change the pharmacy ingredient cost reimbursement methodology from average acquisition cost to the national average drug acquisition cost.
Amends the provisions governing the licensing of hospital crisis receiving centers in order to adopt provisions to allow free-standing psychiatric hospitals which do not have dedicated emergency departments (EDs) to designate crisis receiving center-specialty units (CRC-SUs) as EDs for patients in need of psychiatric crisis treatment, if the CRC-SU meets all of the same regulations as a hospital ED.
Amends the provisions governing telemedicine in order to revise the procedures for claim submissions to comply with recommendations by the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services and align with current managed care organization practices.
Amends the provisions governing school-based medical services covered in the Early and Periodic Screening, Diagnosis and Treatment Program and school-based behavioral health services in order to: 1) add services categorized as 504 plans, individual health plans or otherwise medically necessary in addition to those covered by an individual education plan, to the services available for school-based Medicaid claiming; 2) amend the reimbursement methodology to expand allowable billing providers for direct/therapy and nursing services; and 3) add applied behavioral analysis, personal care services and transportation to allowable Medicaid billing.
Amends the provisions governing the reimbursement methodology for rural health clinics (RHCs) in order to implement an alternative payment methodology to allow RHCs to be reimbursed a separate prospective payment system (PPS) rate for behavioral health and dental services which is at the same rate as the existing all-inclusive encounter PPS rate when such services are rendered on the same day as a medical visit.
Amends the provisions governing intermediate care facilities for individuals with intellectual disabilities in order to align the Rule language relative to transitional rates for public facilities with the Medicaid State Plan amendment approved by the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services, and to ensure that the provisions are accurately promulgated in a clear and concise manner in the Louisiana Administrative Code.
Amends the provisions governing the reimbursement methodology for federally qualified health centers (FQHCs) in order to implement an alternative payment methodology to allow FQHCs to be reimbursed a separate prospective payment system (PPS) rate for behavioral health and dental services which is at the same rate as the existing all-inclusive encounter PPS rate when such services are rendered on the same day as a medical visit.
Continues the provisions of the July 5, 2018 Emergency Rule which amended the provisions governing the reimbursement methodology for nursing facilities in order to adopt provisions governing the transition of a private nursing facility to a state-owned or operated nursing facility through a change of ownership.