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Amends the provisions governing Health Services for American Indians in order to align the on-site requirements for physicians in tribally operated 638 facilities with the regulations at 42 CFR 440.90 and §1905(a)(9) of the Social Security Act.
Continues the provisions of the July 1, 2023 Emergency Rule which amended the provisions governing managed care for physical and behavioral health in order to align the medical loss ratio period for the dental benefit plan manager and the Healthy Louisiana managed care organizations with the capitation rating period for the purposes of required reporting, in compliance with 42 CFR 438.74.
Continues the provisions of the May 12, 2023 Emergency Rule which adopted provisions in the Professional Services Program to continue to provide reimbursement for physician directed treatment-in-place ambulance services after the Coronavirus Disease 2019 (COVID-19) public health emergency ended on May 11, 2023.
Continues the provisions of the July 1, 2023 Emergency Rule which amended the provisions governing reimbursement in the Medical Transportation Program in order to align the reimbursement rates established for emergency ambulance services and providers with current practice for Medicaid managed care and fee-for-service in compliance with the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services requirement to transition from the Full Medicaid Pricing program to an approved federal supplemental payment program.
Continues the provisions of the May 15, 2023 Emergency Rule which amends the provisions governing directed payments in order to reserve the right to discontinue interim directed payments to any hospital whose projected recoupment is greater than 50 percent or who discontinues operations during or prior to the directed payment contract period.
Adopts provisions governing medically necessary inpatient services furnished to Louisiana Medicaid beneficiaries by out-of-state hospitals in order to align the reimbursement rates for those services with current in-state inpatient per diem rates for like hospitals/services.
Adopts provisions establishing the standards for participation for fiscal employer agents that provide financial management services for self-directed home and community-based waiver services administered by the Office of Aging and Adult Services and the Office for Citizens with Developmental Disabilities.
Continues the provisions of the July 1, 2023 Emergency Rule which amended the provisions governing provider fees for emergency ground ambulance services in order to ensure that the language in the administrative rule reflects the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services requirement that reimbursement for these services transition from the Full Medicaid Pricing program to an approved federal supplemental payment program.
Amends the provisions governing the Direct Service Worker (DSW) Registry to ensure that prior to hiring a DSW or trainee, the licensed and/or certified health care provider ensures that the individuals are at least 18 years of age or that the individuals are at least 16 years of age and have received an age restriction exception from the Office for Citizens with Developmental Disabilities or the Office of Aging and Adult Services.
Amends the provisions governing methods of payment in the Pharmacy Benefits Management Program in order to: 1) change the reimbursement methodology for clotting factor products to a state generated actual acquisition cost ingredient cost and a unit based professional dispensing fee; and 2) limit clotting factor products to pharmacy claims only, in compliance with U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services requirements.
Amends the provisions governing eligibility for the Medical Assistance Program in order to align the exclusions to the 12-month continuous eligibility coverage period for children in the administrative Rule with the Medicaid and Children’s Health Insurance Program (CHIP) State Plans approved by the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services.
Amends LAC 50:V.Chapter 9 to remove obsolete non-rural, non-state hospital provisions and to repeal uncodified inpatient hospital services rules governing Medicaid transplant services and well baby care reimbursement in order to promulgate these provisions in a codified format for inclusion in the Louisiana Administrative Code.