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Recovery Audit Contractor Program LAC 50:I.Chapter 85
Continues the provisions of the November 20, 2014 Emergency Rule which adopted provisions to establish the Recovery Audit Contractor program.
LDH News
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Professional Services Program - Reimbursement Methodology - Supplemental Payments LAC 50:IX.15151 and 15153
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 in the Louisiana Administrative Code.
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Inpatient Hospital Services - High Medicaid Hospitals - Supplemental Payments Pool Reduction LAC 50:V.953
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.
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Disproportionate Share Hospital Payments – Major Medical Centers LAC 50:V.2715
Continues the provisions of the February 20, 2017 Emergency Rule which amended the provisions of the June 30, 2016 Emergency Rule governing disproportionate share hospital (DSH) payments to major medical centers located in the central and northern areas of Louisiana in compliance with U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) requirements.
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Inpatient Hospital Services - Graduate Medical Education - Supplemental Payments Pool Elimination LAC 50:V.1331
Amends the provisions of the March 2, 2017 Emergency Rule governing the reimbursement methodology for inpatient hospital services which amended the provisions of the March 1, 2017 Emergency Rule which eliminated the pool for supplemental payments for graduate medical education in order to make technical revisions to ensure that the provisions are appropriately formatted in the Louisiana Administrative Code.
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Professional Services Program - Reimbursement Methodology - State-Owned or Operated Professional Services Practices LAC 50:IX.15110 and 15113
Continues the provisions of the May 1, 2017 Emergency Rule which amended the provisions governing the Professional Services Program in order to revise the reimbursement methodology for 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.
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Professional Services Program - Enhanced Federal Medical Assistance Percentage Rate for Preventive Services LAC 50:IX.15101
Continues the provisions of the May 15, 2017 Emergency Rule which amended the provisions governing reimbursement for professional services in the Medical Assistance Program in order to establish provisions governing the enhanced one percent Federal Medical Assistance Percentage rate increase for the coverage of specified preventive services.
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Pharmacy Benefits Management Program - Managed Care Supplemental Rebates LAC 50:XXIX.1103
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.
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Abortion Facilities - Licensing Standards LAC 48:I.4431
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.
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June 2017 Legislative Oversight Committee Activity
The June 2017 Legislative Oversight Committee reports have been submitted to the respective legislative oversight committees in accordance with R.S. 49:968(D)(1)(b)(c)
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Gov. Edwards Applauds the Trump Administration for Naming Louisiana One of the Toughest States on Fighting Medicaid Fraud
Today, Gov. John Bel Edwards announced that the Trump Administration’s Office of Inspector General Department of Health and Human Services audit has found that Louisiana’s Medicaid program has complied with the federal fraud reporting requirements, has the proper procedures in place to report fraud and is not in need of any recommendations for improvement. Louisiana is one of only four states to pass this audit since 2014.
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Survey: 1 in 4 Adults Would Swim with Diarrhea
Beginning on Memorial Day, Americans have started heading to the pools as the unofficial start of the swimming season is underway. But, a new survey reveals that there may be more in the pool than just water.