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• November 14, 2017

  Managed Care for Physical and Behavioral Health - Member Grievances and Appeals LAC 50:I.Chapter 37

  Amends provisions governing managed care for physical and behavioral health in order to align the current Rule with the Code of Federal Regulations and the Louisiana Administrative Code which will: 1) revise timeframes for members to initiate state fair hearings and request appeals; 2) revise the timeframe for managed care organizations to resolve grievances; 3) update definitions to align with federal Rule changes; 4) revise record retention requirements; and 5) clarify reporting requirements.

• November 14, 2017

  Managed Care for Physical and Behavioral Health - Independent Review Process for Provider Claims LAC 50:I.3111

  Amends the provisions governing managed care for physical and behavioral health in order to adopt provisions for an independent review process for healthcare providers who have received an adverse determination on managed care organization claims payments.

• November 14, 2017

  Laboratory and Radiology Services - Termination of Coverage for Proton Beam Radiation Therapy LAC 50:XIX.4334

  Amends the provisions governing laboratory and radiology services to terminate coverage and reimbursement of proton beam radiation therapy for recipients 21 years of age and older.

• November 14, 2017

  Home and Community-Based Behavioral Health Services Waiver LAC 50:XXXIII.8103, 8501 and 8701

  Amends provisions governing children’s behavioral health services provided through the Home and Community-Based Behavioral Health Services Waiver in order to: 1) reflect the coordinated system of care contractor moving from a non-risk contract to a full-risk capitated contract; and 2) remove the requirement for the Office of Behavioral Health certification of providers.

• November 14, 2017

  Facility Need Review - Behavioral Health Services Providers LAC 48:I Chapter 125

  Amends the provisions governing the facility need review (FNR) process to adopt provisions to include behavioral health services providers of psychosocial rehabilitation and/or community psychiatric support and treatment services in the FNR program..

• November 14, 2017

  Disproportionate Share Hospital Payments - Major Medical Centers LAC 50:V.2715

  Continues the provisions of the June 30, 2016 and February 20, 2017 Emergency Rules which adopted provisions to establish a qualification criteria and disproportionate share hospital payment methodology for major medical centers located in the central and northern areas of Louisiana.

• November 14, 2017

  Children’s Behavioral Health Services LAC 50:XXXIII. Chapters 21-27

  Amends the provisions governing children’s behavioral health services in order to: 1) reflect the coordinated system of care contractor moving from a non-risk contract to a full-risk capitated contract; 2) remove the requirements for the Office Behavioral Health certification of providers and for prior approval of services; and 3) clarify the exclusion criteria for services rendered by institutes for mental disease.

• November 14, 2017

  Behavioral Health Services - Substance Use Disorders Services LAC 50:XXXIII.Chapters 141-147

  Amends the provisions governing substance use disorders (SUD) services rendered to children and adults in order to: 1) reflect the coordinated system of care contractor moving from a non-risk contract to a full-risk capitated contract; 2) remove the requirements for the Office of Behavioral Health certification of providers and for prior approval of SUD services; 3) clarify the exclusion criteria for institutes for mental disease; and 4) clarify the requirements for residential addiction treatment facilities.

• November 14, 2017

  Behavioral Health Services - Healthy Louisiana and Coordinated System of Care Waiver LAC 50:XXXIII.Chapters 1-7

  Amends the provisions governing the Healthy Louisiana and Coordinated System of Care (CSoC) Waiver in order to: 1) reflect the CSoC contractor moving from a non-risk contract to a full-risk capitated contract; 2) clarify the CSoC contractor procurement process; 3) remove the requirements for mandatory enrollment of CSoC participants and the Office of Behavioral Health certification of providers; and 4) clarify the grievance and appeals process.

• October 11, 2017

  Targeted Case Management - Reimbursement Methodology - Early and Periodic Screening, Diagnosis and Treatment LAC 50:XV.10701

  Amends the provisions governing reimbursement for targeted case management services provided to participants in the Early and Periodic Screening, Diagnosis and Treatment program in order to adopt a payment methodology based on a flat monthly rate rather than 15-minute increments.

• October 11, 2017

  Professional Services Program - State-Owned or Operated Professional Services Practices - Enhanced Reimbursement Rates LAC 50:IX.15110 and 15113

  Amends the provisions governing the Professional Services Program in order to revise the reimbursement methodology governing services rendered by physicians and other professional services practitioners employed by, or under contract to provide services in affiliation with, a state-owned or operated entity in order to enhance the reimbursement rates.

• October 11, 2017

  Managed Care for Physical and Behavioral Health - Applied Behavior Analysis-Based Therapy Services Integration LAC 50:I.3507

  Amends the provisions governing managed care for physical and behavioral health in order to include applied behavior analysis-based therapy in the specialized behavioral health services the managed care organizations that participate in the Healthy Louisiana program are required to provide.