Results for provider policy

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  Data Action Team (DAT)

  Data Action Team collects & analyzes health-related data for women, youth & families. The team guides program plans, informs policy & evaluates health services.

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  Critical Incident Reporting for OCDD

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  Step 4: Formalize the Process and Sustain Change

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  2013 Managed Care Transparency Report

  Managed Care 1.0 Amerigroup Healthy Blue Community Health Solutions LaCare AmeriHealth Caritas Louisiana Healthcare Connections UnitedHealthcare Community Plan Act 212 of the 2013 Regular Session of the Louisiana Legislature requires the Louisiana Department of Health and Hospitals (DHH) to submit annual reports concerning the Bayou Health program to the Legislature’s Senate and House Committees on Health and Welfare. The following Bayou Health Transparency Report: Calendar Year (CY) 2013 is intended to provide all information outlined in Act 212 for the second annual report to the Legislature. This report presents information on the Bayou Health program during the 2013 calendar year. Information and data for inclusion in this report were collected and provided by the contracted Bayou Health plans. The health plans’ internal policies and procedures for collection of data were validated by DHH’s contracted external quality review organization (EQRO), Island Peer Review Organization (IPRO), in conjunction with 2013 external quality reviews. An additional validation was performed by either the National Committee for Quality Assurance (NCQA) or the Utilization Review Accreditation Commission (URAC) as part of the contractually required health plan accreditation process. Plans are contractually required to obtain accreditation from either NCQA or URAC for their Bayou Health plan serving Louisiana members. All Bayou Health plans have obtained accreditation from those national accrediting bodies NCQA or URAC, which are rigorous processes involving comprehensive reviews of the plans’ policies, procedures and practices.

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  Informational Bulletins

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  Free-standing Birth Centers– LAC 48:I.Chapter 67 - October 15, 2024

  The Department of Health, Health Standards Section (the department) proposes to amend the provisions governing the licensing of Free-standing Birth Centers (FSBC) providers in order to comply with the requirements of the following Acts of the 2024 Regular Session of the Louisiana Legislature: Act 122 that requires FSBC providers to, prior to discharge following birth, provide the mother and her family members information about post-birth warning signs, including symptoms and available resources; and Act 624 that requires FSBC providers to implement workplace violence mitigation initiatives. In compliance with Acts 122 and 624, the department hereby proposes to amend the provisions governing the licensing of FSBCs in order to update general provisions for licensure, requirements for policies and procedures, and client discharge processes. The department also proposes to amend the provisions governing the licensing of FSBC providers in order to update requirements for provisional licensure and deemed status.

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  2014 Managed Care Transparency Report

  Managed Care 1.0 Amerigroup Healthy Blue Community Health Solutions LaCare AmeriHealth Caritas Louisiana Healthcare Connections UnitedHealthcare Community Plan This report is the third in a series produced by the Louisiana Department of Health to satisfy statutory reporting requirements intended to ensure the following outcomes are being achieved by Medicaid managed care programs:  improved care coordination with patient-centered medical homes for Medicaid recipients;  improved health outcomes and quality of care;  increased emphasis on disease prevention and the early diagnosis and management of chronic conditions;  improved access to Medicaid services;  improved accountability with a decrease in fraud, abuse and wasteful spending; and  a more financially stable Medicaid program. The first and second reports included 23 measures as outlined in Act 212 of the 2013 Regular Legislative Session. The first report, submitted to the Legislature on January 2, 2014, covered July 2012 through June 2013 (State Fiscal Year 2013). The second report, submitted to the Legislature on December 31, 2014, covered January 2013 through December 2013 (Calendar Year 2013). The Department shifted the reporting periods, from State Fiscal Year (SFY) in the first report to Calendar Year (CY) in the second report, duplicating six months of the first report (January 2013 through June 2013). The shift in reporting periods provided for complete claims data given Act 212’s requirement of annual transparency report submission by January 1 and Medicaid’s timely filing policy which allows providers 365 days from the date of service to file a claim for payment. Act 158 of the 2015 Regular Legislative Session modified reporting requirements for the transparency report, adding three new measures and clarifying the reporting period. This third report includes 26 measures, and it covers July 2013 through June 2014 (State Fiscal Year 2014), duplicating six months of the second report (July through December 2013). All measures are reported on a fiscal year basis, except the following measures which are reported on a calendar year basis per the contract between the Department and the health plans:  Section 7 – Medical Loss Ratio  Section 8 – Health Outcomes  Section 9 – Member and Provider Satisfaction Surveys  Section 10 – Audited Financial Statements  Section 25 – Medicaid Drug Rebates Act 158 provides sufficient time for complete claims reporting for a state fiscal year by shifting the due date for report submission from January 1 to June 30. This report covers the original contracting period for the Medicaid managed care program (beginning February 1, 2012) which includes physical and basic behavioral health services provided by both fullrisk managed care organizations, called prepaid health plans and referred to in this document as managed care organizations (MCOs), and plans serving as primary care case management (PCCM) entities, referred to as shared savings health plans. Information included in this report was collected from multiple sources. The Medicaid Management Information System (MMIS) and the Management Administrative Reporting Subsystem (MARS Data Warehouse) are maintained by the Medicaid program’s contracted fiscal intermediary, which in State Fiscal Year 2014 was Molina Healthcare. The MMIS contains detailed recipient and provider information and the MARS Data Warehouse contains claims payment information. The state administrative system, called ISIS, is maintained by the Office of Technology Services within the Division of Administration and contains information on payments to health plans. The provider registry is maintained by Molina and contains information submitted by the health plans or their contracted providers. The provider registry is updated weekly with new information overwritten onto older information, which limits the utility of the data to point-in-time information. To the greatest extent possible, the data originate from state systems rather than the health plans. Where unavailable from state sources, data were collected from the health plans, sourced from either routine reporting deliverables or ad hoc reports requested specifically for this purpose. Data included in this report were independently validated by Myers and Stauffer, an audit contractor of the Department. Myers and Stauffer reviewed for reasonability the data extraction code or process that the health plans or the Department used to generate data. For data originating from the MARS Data Warehouse or the MMIS, Myers and Stauffer generated its own data for each health plan and compared its results to the results the Department produced. For data originating from the health plans, Myers and Stauffer reviewed plan responses to a survey developed by Myers and Stauffer to document the process the plans used to generate the data, as well as policies and procedures in place to collect, track and report data. Where Myers and Stauffer found inconsistencies above or below the 10 percent variance threshold established by the Department, they made recommendations to the Department and/or the health plan to improve the method used to collect data. See Appendix 14.IX for the survey instrument. To ensure maximum reliability, subject matter experts within the Department and Myers and Stauffer also reviewed the data. In some cases, the health plans also reviewed data pulled on their plans by the Department for reasonability. In addition, health plans’ internal policies and procedures for collection of data were validated by the Department’s contracted external quality review organization (EQRO), Island Peer Review Organization (IPRO), in conjunction with annual external quality reviews. An additional validation was performed by either the National Committee for Quality Assurance (NCQA) or the Utilization Review Accreditation Commission (URAC) as part of the contractually required health plan accreditation process. Plans are contractually required to obtain accreditation from either NCQA or URAC for their Bayou Health plan serving Louisiana members. All Bayou Health plans have obtained accreditation from these national accrediting bodies, which are rigorous processes involving comprehensive reviews of the plans’ policies, procedures and practices.

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  Medicaid Policy Gateway

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  Ambulatory Surgical Center – Licensing Standards LAC 48:I.Chapter 45 - August 10, 2023

  Amends the provisions governing the licensing of ambulatory surgical centers (ASCs) in order to require ASCs to adopt and implement policies for a surgical smoke plume evacuation plan for surgical procedures using heat-producing equipment, in compliance with Act 35 of the 2023 Regular Session of the Louisiana Legislature.

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  Nurse Staffing Agencies Licensing Standards 48:I.Chapter 77 - November 13, 2023

  The Department of Health, Health Standards Section, proposes to amend the provisions governing the licensing of nurse staffing agencies in order to add and update definitions, adjust social media policy requirements, revise administrator requirements, and modify initial licensure and change of ownership requirements.

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  2022 Louisiana Pregnancy Risk Assessment Monitoring System (PRAMS) Data Report

  The Louisiana Pregnancy Risk Assessment Monitoring System (PRAMS) is a population-based survey of women who deliver a live-born infant within a given calendar year. The 2022 Louisiana PRAMS Data Report, a compilation of Louisiana PRAMS results for selected indicators, highlights data for births occurring in 2022. In 2022, there were 55,848 live births that satisfied the Louisiana PRAMS inclusion criteria, of which 1,234 were sampled. Of this sample, there were 601 respondents, resulting in a 49.2 percent overall weighted response rate. Louisiana PRAMS data can be used by program planners, health care providers, policy makers, and public health leaders to design, implement, and evaluate programs and services for women and infants in Louisiana.

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  Long Term-Personal Care Services LAC 50:XV.Chapter 129 - September 10, 2024

  Amends the provisions governing long term personal care services (LT-PCS) to update language pertaining to rights and responsibilities, cost reporting requirements, and add new language for a rate methodology to align current policies and procedures under the home and community based services waivers with the Louisiana Administrative Code.

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  Case Management Licensing Standards – LAC 48:I.Chapter 49

  Baton Rouge, Louisiana - April 17, 2025 - The department proposes to amend the provisions governing the licensing of case management in order to: (1) modify qualifications for case managers and supervisors, (2) adjust the timeframe in which providers must respond to the department’s written report of licensing inspection findings, (3) change how often a case manager must conduct visits with the consumer/guardian as part of the linkage and monitoring/follow-up process, and (4) require the development of policy and procedure for preventing, responding to, reporting, and mitigating instances of healthcare workplace violence. Amends the provisions governing targeted case management (TCM) under the New Opportunities Waiver, early and periodic screening, diagnosis and treatment, and the EarlySteps Program in order to clarify language and ensure the requirements for TCM services are accurately reflected throughout the administrative Rule.

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  Epidemiology, Assessment, & Evaluation (EAE) Unit

  The Maternal and Child Health (MCH) Program's Epidemiology, Assessment & Evaluation (EAE) Unit collects, links, analyzes, and interprets data related to women, children, and family health.

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  Opioid Surveillance

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  Nursing Services Program

  Nursing Services supports and acknowledges the primary mission of the Office of Public Health to take knowledge about wellness and prevention of illness, disability and premature death and translate the knowledge into community services for the people of Louisiana.

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  Medicaid Managed Care Policies & Procedures

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  Dental Benefit Plan Manager Policies

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  Regional and State Advisory Committee

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  Medicaid Provider Manuals