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Continues the provisions of the July 1, 2018 Emergency Rule which amended the provisions governing healthcare services provider fees in order to calculate, levy and collect an assessment for each assessed hospital, with the exception of facilities prohibited from participating in the Medicare Program and to increase provider fees for emergency ground ambulance service providers.
Amends the provisions governing the Community Choices Waiver (CCW) in order to: 1) align the provisions governing target population, service definitions and provider qualifications with the waiver approved by the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services; 2) eliminate the non-medical transportation service; 3) amend the criteria for CCW priority offers to specify priority for individuals admitted to, or residing in, nursing facilities for whom Medicaid is the sole payer source; 4) change references to the minimum data set-home care to the International Resident Assessment Instrument (interRAI) assessment tool; and 5) allow OAAS to grant exceptions to waiver discharges for interruptions due qualifying circumstances.
Amends the provisions governing managed care for physical and behavioral health in order to allow MCOs to utilize skilled nursing facilities for members who transition from acute care hospital services as a step-down continuum of care and to align the governing authorities with current operations and practices.
Amends the provisions governing outpatient hospital services in order to repeal the provisions governing duration of outpatient status to remove these procedural requirements from the Louisiana Administrative Code.
Amends the provision governing rural health clinics reimbursements in order to implement a payment methodology for long-acting reversible contraceptive devices outside of the prospective payment system rates.
Amends the provisions governing the reimbursement methodology for Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICFs/IID) in order to: 1) clarify the provisions governing cost reports to align the direct care floor requirements for pervasive plus supplemental payments and complex care add-on payments with current practices; 2) require the annual renewal of the complex care add-on rate and submission of the associated documentation; and 3) eliminate the qualifying loss review requirement.
Amends the provisions governing the licensing standards for home and community-based services (HCBS) providers in order to clarify the requirements for contract services to ensure that HCBS providers utilize contractors and/or subcontractors in compliance with all state and federal requirements.
Amends the provisions governing managed care for physical and behavioral health in order to clarify that Medicaid recipients who are in need of applied behavior analysis-based therapy must access these services through a managed care organization under the Healthy Louisiana program.
Amends the provisions governing the reimbursement methodology for federally qualified health centers (FQHCs) in order to establish cost reporting requirements when there is a change in the scope of services rendered by the FQHC to align these provisions with the corresponding approved Medicaid State Plan and operational practices, and to ensure that they are appropriately codified into the Louisiana Administrative Code in a clear and concise manner.
Amends the provisions governing the licensing standards for adult residential care providers (ARCPs) in order to correct a citation in the June 20, 2015 Rule relative to the involuntary termination process for ARCP residency agreements, and to ensure that these provisions are appropriately promulgated in the Louisiana Administrative Code.
Amends the provisions governing the Pharmacy Benefits Management Program to revise the reimbursement methodology for physician-administered drugs in a physician office setting in order to bring the rates current and to incorporate a mechanism for periodic updates to the rates in compliance with U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services requirements.
Amends the provisions governing the standards for payments for nursing facilities in order to clarify the definitions of admission and continued stay, clarify the provisions governing the levels of care pathways and eliminate the behavior pathway for meeting nursing facility level of care.