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Amends the provisions governing the TOP$ State Supplemental Rebate Agreement Program in order to include pharmacy utilization of managed care organizations (MCOs) that participate in the Healthy Louisiana (formerly Bayou Health) Program and implement a single state managed preferred drug list for selected therapeutic classes to maximize supplemental rebates on MCO utilization.
Continues the provisions of the December 3, 2016 Emergency Rule which amended the provisions governing the licensing standards for outpatient abortion facilities in order to comply with the provisions of Acts 97, 563 and 593 of the 2016 Regular Session of the Louisiana Legislature which increased the time period for pre-operative services, mandated the distribution of printed information about services for pregnant women, and established provisions for the disposal of fetal remains.
Amends the provisions governing managed care for physical and behavioral health in order to allow Medicaid recipients enrolled in the LaHIPP Program to access behavioral health services only through the managed care organizations that participate in the Healthy Louisiana (formerly Bayou Health) Program.
Amends the provisions governing the Pharmacy Benefits Management Program in order to clarify the provisions of the January 20, 2017 Notice of Intent and to: 1) revise the definitions for usual and customary charge and general public; 2) clarify billing/reimbursement requirements for 340B entities that are carved-out of Medicaid; 3) revise the reimbursement language for Federal Supply Schedule and Nominal Price; 4) revise the definition for contract pharmacy; and 5) clarify professional dispensing fee provisions.
Continues the provisions of the February 20, 2017 Emergency Rule which amended the provisions governing the Professional Services Program to revise the reimbursement methodology for supplemental payments to physicians and other professional service practitioners in order to clarify the qualifying criteria for these payments and to reformat the provisions to ensure they are promulgated in a clear and concise manner.
Amends the provisions governing the coverage of former foster care adolescents in order to terminate the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS)-approved state option to provide Medicaid coverage to youth formerly enrolled in foster care under the responsibility of another state.
Continues the provisions of the March 1, 2017 Emergency Rule which amended the provisions governing inpatient hospital services to reduce the total supplemental payments pool for non-rural, non-state hospitals classified as high Medicaid hospitals
Continues the provisions of the March 1, 2017 and March 2, 2017 Emergency Rules which amended the provisions governing inpatient hospital services to eliminate the total supplemental payments pool for graduate medical education payments to qualifying acute care hospitals.
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.