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Amends the provisions governing the Pharmacy Benefits Management Program to update copay tier payment schedule to align with the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services recommended guidelines.
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.
Amends the provisions governing the supports waiver services to add assistive technology with remote features to specialized medical equipment, place service limits on assistive technology with remote features and incontinence supplies, include additional requirements for day habilitation and prevocational services providers and require that community life engagement providers must possess a valid adult day care license and provide day habilitation services.
Amends the provisions governing Support Coordination Standards for Participation to align the administrative Rule with current policy and procedures under the Home and Community-Based Services (HCBS) Waivers relative to general provisions, administration and organization, provider responsibilities, and to establish cost reporting requirements for support coordination agencies providing waiver services.
Amends the provisions governing Residential Options Waiver (ROW) services to clarify the tiered waiver approach in OCDD waivers and add new services including technology supports with remote features, incontinence supplies, the Person Emergency Response System, Community Life Engagement, and self-directed services as well as dismissal from self-direction.
Amends the provisions governing the Pharmacy Benefits Management Program in order to align the language in the Louisiana Administrative Code relative to vaccine administration and fees for Medicaid coverage with the CMS-approved State Plan amendment..
Amends the provisions governing Medicaid managed care organizations (MCOs) to update and align language in the administrative Rule with the preprints that are approved by the Department of Health and Human Services, Centers for Medicare and Medicaid Services that qualified hospitals with a balance owed as a result of reconciliation shall pay the amounts owed to the MCOs or the department.
Amends the provisions governing the Pharmacy Benefits Management Program in order to align the language in the Louisiana Administrative Code with the required changes requested by CMS to the State Plan relative to shortages of drugs not on the covered drug list, including drugs authorized for import by the Food and Drug Administration (FDA) that may be covered when deemed medically necessary during drug shortages identified by the FDA.
Amends the provisions governing the medical transportation program to establish guidelines for the administration and distribution of Elevated Level of Care (ELOC) services by non-emergency medical transportation (NEMT) vendors that meet the criteria to provide an elevated level of care service to Medicaid beneficiaries utilizing this service, and to clarify language regarding non-emergency medical ambulance transportation (NEAT) services.
Adopts provisions governing qualifying criteria and reimbursement methodology for high Medicaid utilization academic hospitals to increase payments for outpatient hospital services.
Adopts provisions governing qualifying criteria and reimbursement methodology for high Medicaid utilization academic hospitals to increase payments for inpatient hospital services.
Amends the provisions governing provider screening and enrollment in order to comply with U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services requirements to align the provisions governing out-of-state enrollment and single case agreements with the Medicaid Provider Enrollment Compendium, to codify provisions for informal hearings and appeal rights for provider enrollment denials and terminations, and to ensure that the administrative Rule is consistent with current practices.