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Amends the provisions governing the Louisiana Children's Health Insurance Program (LaCHIP) Phase V to comply with Department of Health and Human Services, Centers for Medicare and Medicaid Services rule [42 CFR § 457.340(e)] for twelve-month continuous eligibility and procedures governing non-payment of premiums.
Medicaid Program Integrity – Fraud, Waste and Abuse Recovery LAC 50:I.Chapters 41-46 Repeals the existing language relating to Provider Fraud and Recovery and codifies current practices.
Amends the provisions governing children and adult mental health services to expand the provider types authorized to render therapeutic services. This proposed rule would allow Medicaid to pay for therapy services provided by psychology interns in approved American Psychiatric Association internship programs, as well as by provisionally licensed psychologists. This is being done in accordance with Senate Concurrent Resolution 10 of the 2024 Regular Legislative Session.
Amends the provisions governing reimbursement methodology for ICFs/IID to remove the deadline for sending out payments and remove language that limited which facilities were eligible to those active and enrolled on the date of payment. This will provide the department with greater flexibility in distributing payments and will allow facilities to qualify based on the original eligibility date of July 1, 2024.
Amends the provisions governing managed care organizations in order to remove parts that are no longer relevant, remove the annual enrollment period, and allow beneficiaries to change which MCO they are enrolled with twice in a calendar year.
Amends the provisions governing dental benefits program managers to simplify enrollment rules, allowing beneficiaries to transfer to another dental benefit program manager (DBPM) up to two times per calendar year.
Repeals LAC 50:III.505 to align with recent legislative changes enacted through Act 427 of the 2025 Regular Session, which prohibits the department from accepting Medicaid eligibility determinations made by a Federally-Facilitated Exchange, including the Federally-Facilitated Marketplace.
Adopts provisions governing doula services in accordance with Act 228 of the 2025 Regular Session of the Louisiana Legislature. This proposed rule establishes coverage and reimbursement criteria for nonclinical maternal health services provided by registered doulas before, during, and after childbirth.
Amends the provisions governing targeted case management in order to add ventilator care coordination as a service. This proposed Rule establishes the requirements for beneficiaries to receive these services, the requirements for Medicaid-participating hospitals and providers, and clarifies the reimbursement rate for targeted case management services.
Amends the provisions governing Medicaid managed care organizations (MCOs) to allow practitioner and practitioner groups to participate in directed payments, in accordance with the preprint approved by Centers for Medicare and Medicaid Services (CMS).
Continues the provisions of the July 1, 2025 Emergency Rule (Louisiana Register, Volume 51, Number 7). These higher reimbursement rates may incentivize more providers to participate in Medicaid. Medicaid physician payment rates have historically been significantly lower than those of Medicare, often averaging around two-thirds of the Medicare rate.
Continues the July 1, 2025 Emergency Rule which adopted cell and gene therapy model that provides additional supplemental and federal rebates for gene therapies for sickle cell disease.