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Amends the provisions governing licensing standards for behavioral health service providers in order to: 1) clarify the existing provisions; 2) ensure consistency with other licensing Rules, regulations and processes; and 3) provide for requirements for partial hospitalization services for substance abuse.
Amends the provisions governing admissions for nursing facilities by revising the procedures for the preadmission screening and resident review process in order to: 1) remove the requirement that the level I Preadmission Screening and Resident Review (PASRR) form be completed by a physician; 2) extend the number of days that the level II authority may make an advance group determination for individuals who require convalescent care in a nursing facility; 3) require nursing facilities to notify the level II authority if a PASRR was not completed or was completed incorrectly; and 4) clarify existing provisions.
Continues the provisions of the October 1, 2013 Emergency Rule governing the Pharmacy Benefits Management Program which established provisions for the Medicaid Program’s participation in The Optimal PDL $olution (TOP$) State Supplemental Rebate Agreement Program.
Continues the provisions of the January 1, 2017 Emergency Rule which amended the provisions governing the reimbursement methodology for outpatient hospital services in order to increase the Medicaid reimbursement rate paid to non-rural, non-state hospitals and children’s specialty hospitals in compliance with the requirements of House Concurrent Resolution (HCR) 51 of the 2016 Regular Session of the Louisiana Legislature.
Continues the provisions of the January 1, 2017 Emergency Rule which amended the provisions governing the reimbursement methodology for inpatient hospital services to increase the Medicaid reimbursement rate paid to non-rural, non-state hospitals in compliance with the requirements of House Concurrent Resolution (HCR) 51 of the 2016 Regular Session of the Louisiana Legislature.
Repeals the provisions governing the Family Planning Waiver due to the expiration of the §1115 waiver authority on December 31, 2014.
Amends the provisions governing disproportionate share hospital payments in order to make technical revisions to ensure that the provisions governing the qualifying criteria are appropriately formatted in a clear and concise manner in the Louisiana Administrative Code.
Amends the provisions governing the reimbursement methodology for disproportionate share hospital payments to Louisiana low-income academic hospitals in order to revise the reimbursement schedule from annual to quarterly payments.
Repeals and replaces the licensing standards governing ambulatory surgical centers in order to: 1) clarify the existing provisions; 2) provide for inactivation of the provider license in the event of specific qualifying events or circumstances; 3) establish provisions which allow ambulatory surgical centers to enter into use agreements; and 4) ensure consistency with other licensing rules, regulations and processes.
Amends the provisions governing the reimbursement methodology in the Pharmacy Benefits Management Program in order to clarify requirements regarding 340B-covered entities, and to revise the reimbursement methodology to include federal upper limits (FUL), new copayment exemptions and over-the-counter medications added for expansion benefits pursuant to U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) recently released regulations.
Reinstates the Louisiana Health Insurance Premium Payment Program (LaHIPP) in order to reduce Medicaid costs by establishing or maintaining a third party resource as the primary payer of the Medicaid recipient’s medical expenses.
Amends the provisions governing managed care for physical and behavioral health in order to exclude Louisiana Health Insurance Premium Payment Program (LaHIPP) participants from participation in managed care for physical and behavioral health.