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Amends the provisions governing outpatient hospital services in order to remove the 12 visits per year limit on physician services provided in a clinic in an outpatient hospital setting.
Amends the provisions governing the licensing of pain management clinics to provide for the expiration of licensure exemptions and related matters in compliance with Act 714 of the 2014 Regular Session of the Louisiana Legislature, and to revise these provisions to ensure that they are consistent with licensing standards for other health care providers and current enforcement processes.
Repeals the September 20, 1975 Rule governing physician visits, adopts provisions in the Professional Services Program governing physician services in order to remove the limits from outpatient physician visits, and ensures that these provisions are promulgated in a codified format for inclusion in the Louisiana Administrative Code.
Amends the provisions governing rural health clinic services in order to remove the 12 visits per year limit for Medicaid recipients 21 years of age and older.
Amends the provisions governing adult behavioral health services in order to: 1) reflect the integration of specialized behavioral health services into the Managed Care for Physical and Basic Behavioral Health model; 2) update the service criteria for culturally competent care; 3) change the recipient qualifications; 4) revise the assessment criteria; 5) remove service limitations for psychosocial rehabilitation and crisis intervention services; and 6) revise the reimbursement methodology to reflect capitation payments to managed care organizations rather than a statewide management organization.
Amends the provisions governing behavioral health services coordinated by the statewide management organization (SMO) to: 1) narrow the SMO’s scope of service administration to coordinated system of care (CSoC) services only; 2) reflect the integration of specialized behavioral health services (with the exception of CSoC services) into the Managed Care for Physical and Basic Behavioral Health model; 3) revise the enrollment provisions; and 4) revise the reimbursement methodology to reflect capitation payments to managed care organizations rather than a statewide management organization.
Amends the provisions governing substance abuse services to: 1) reflect the integration of specialized behavioral health services into the Managed Care for Physical and Basic Behavioral Health model; 2) revise the provisions governing provider certification; 3) update the terminology and service criteria; and 4) revise the reimbursement methodology.
Amends the provisions governing children’s behavioral health services in order to: 1) narrow the statewide management organization’s scope of service administration to CSoC services only; 2) reflect the integration of specialized behavioral health services (with the exception of CSoC services) into the Managed Care for Physical and Basic Behavioral Health model; 3) delegate provider certification functions to managed care organizations (MCOs); 4) establish coverage for crisis stabilization services; 5) revise the service limitations for psychosocial rehabilitation and crisis intervention services; and 6) revise the reimbursement methodology to reflect capitation payments to managed care organizations rather than a statewide management organization.
Amends the provisions governing home and community-based behavioral health services to: 1) narrow the statewide management organization’s scope of service administration to CSoC services only; 2) reflect the integration of specialized behavioral health services (with the exception of CSoC services) into the Managed Care for Physical and Basic Behavioral Health model; 3) delegate provider certification functions to managed care organizations; and 4) revise the provisions governing the recipient qualifications and the services covered under the waiver.Amends the provisions governing home and community-based behavioral health services to: 1) narrow the statewide management organization’s scope of service administration to CSoC services only; 2) reflect the integration of specialized behavioral health services (with the exception of CSoC services) into the Managed Care for Physical and Basic Behavioral Health model; 3) delegate provider certification functions to managed care organizations; and 4) revise the provisions governing the recipient qualifications and the services covered under the waiver.
Amends the provisions governing managed care for physical and basic behavioral health in order to reflect the integration of specialized behavioral health services into the Managed Care for Physical and Basic Behavioral Health model as a result of the narrowing of the statewide management organization’s scope of service administration for certain behavioral health services. This proposed Rule will also amend the provisions governing recipient participation in order to enroll additional populations into Bayou Health that had been exempt/excluded from participation.
Repeals the provisions governing the Louisiana Health Insurance Premium Payment (LaHIPP) program in order to terminate the program as a result of a budgetary shortfall due to the funding for LaHIPP being removed from the executive budget in state fiscal year 2016.
Amends the provisions governing psychiatric residential treatment facilities to: 1) narrow the statewide management organization’s scope of service administration to CSoC services only; 2) reflect the integration of specialized behavioral health services (with the exception of CSoC services) into the Managed Care for Physical and Basic Behavioral Health model; 3) delegate provider certification functions to managed care organizations; 4) update the provisions governing covered services; 5) revise the service limitations for psychosocial rehabilitation and crisis intervention services; and 6) revise the reimbursement methodology to update these provisions to be consistent with current program operations.