reglab/statecodes huggingface dataset:
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:438.3. False or fraudulent claim; misrepresentation

RS 46:438.3 - False or fraudulent claim; misrepresentation
A. No person shall knowingly present or cause to be presented a false or fraudulent claim.
B. No person shall knowingly engage in misrepresentation or make, use, or cause to be made or used, a false record or statement material to a false or fraudulent claim.
C. No person shall knowingly make, use, or cause to be made or used, a false record or statement material to an obligation to pay or transmit money or property to the medical assistance programs, or to knowingly conceal, avoid, or decrease an obligation to pay or transmit money or property to the medical assistance programs.
D. No person shall conspire to defraud, or attempt to defraud, the medical assistance programs through misrepresentation or by obtaining, or attempting to obtain, payment for a false or fraudulent claim.
E.(1) No person shall knowingly submit a claim for goods, services, or supplies which were medically unnecessary or which were of substandard quality or quantity.
(2) If a managed care health care provider or a health care provider operating under a voucher system under the medical assistance programs fails to provide medically necessary goods, services, or supplies or goods, services, or supplies which are of substandard quality or quantity to a recipient, and those goods, services, or supplies are covered under the managed care contract or voucher contract with the medical assistance programs, such failure shall constitute a violation of Paragraph (1) of this Subsection.
(3) "Substandard quality" in reference to services applicable to medical care as used in this Subsection shall mean substandard as to the appropriate standard of care as used to determine medical malpractice, including but not limited to the standard of care provided in R.S. 9:2794.
F. Each violation of this Section may be treated as a separate violation or may be combined into one violation at the option of the secretary or the attorney general.
G. No action shall be brought under this Section unless the amount of alleged actual damages is one thousand dollars or more.
H. No action brought pursuant to this Section shall be instituted later than ten years after the date upon which the alleged violation occurred.
Acts 1997, No. 1373, §1; Acts 2007, No. 14, §1, eff. June 18, 2007; Acts 2009, No. 426, §1; Acts 2011, No. 185, §1.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:438.4. Illegal acts regarding eligibility and recipient lists

RS 46:438.4 - Illegal acts regarding eligibility and recipient lists
A. No person shall knowingly make, use, or cause to be made or used a false, fictitious, or misleading statement on any form used for the purpose of certifying or qualifying any person for eligibility for the medical assistance programs or to receive any good, service, or supply under the medical assistance programs which that person is not eligible to receive.
B. No unauthorized person, or no authorized person for an unauthorized purpose, shall obtain a recipient list, number, name, or any other identifying information, nor shall that person use, possess, or distribute such information.
C. An action brought pursuant to the provisions of this Section shall be instituted within one year of when the department knew that the prohibited conduct occurred.
Acts 1997, No. 1373, §1.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:438.7. Reduced damages

RS 46:438.7 - Reduced damages
If requested by the secretary or the attorney general, the court may reduce to not less than twice the actual damages or any recovery required to be imposed under the provisions of this Subpart if all of the following extenuating circumstances are found to be applicable:
(1) The violator furnished all the information known to him about the specific allegation to the secretary or attorney general no later than thirty days after the violator first obtained the information.
(2) The violator cooperated fully with all federal or state investigations concerning the specific allegation.
(3) At the time the violator furnished the information concerning the specific allegation to the department or the attorney general, no criminal, civil, or departmental investigation or proceeding had been commenced as to the alleged violation.
Acts 1997, No. 1373, §1; Acts 2011, No. 185, §1.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:438.8. Burden of proof; prima facie evidence; standard of review

RS 46:438.8 - Burden of proof; prima facie evidence; standard of review
A. The burden of proof in an action instituted pursuant to this Part shall be on the medical assistance programs and by a preponderance of the evidence, except that the defendant shall carry the burden of proving that goods, services, or supplies were actually provided to an eligible recipient in the quantity and quality submitted on a claim. In all other aspects, the burden of proof shall be as set forth in the Code of Civil Procedure and other applicable laws.
B. Proof by a preponderance of the evidence of a false or fraudulent claim or illegal remuneration shall be deemed to exist under the following circumstances:
(1) If the defendant has pled guilty to, been convicted of, or entered a nolo contendere plea to a criminal charge in any federal or state court to charges arising out of the same circumstances as would be a violation of this Subpart.
(2) If an order has been rendered against a defendant finding the defendant to have violated this Subpart.
C.(1) The submission of a certified or true copy of an order, civil judgment, or criminal conviction or plea shall be prima facie evidence of the same.
(2) The submission of the bill of information or of the indictment and the minutes of the court shall be prima facie evidence as to the circumstances underlying a criminal conviction or plea.
D.(1) In determining whether a pattern of incorrect submissions exists in regard to an alleged false or fraudulent claim, the court shall give consideration as to whether the total amount of the incorrect submissions by a health care provider is material in relation to the total claims submitted by the health care provider.
(2) "Material" as used in this Subsection shall have the same meaning as defined by rules and regulation promulgated by the secretary in accordance with the Administrative Procedure Act which incorporate the same definition of "material" as recognized by the American Institute of Certified Public Accountants.
Acts 1997, No. 1373, §1.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:439.3. Qui tam action procedures; alternative remedies

RS 46:439.3 - Qui tam action procedures; alternative remedies
Notwithstanding any other provision of this Subpart, the secretary or the attorney general may elect to pursue an administrative or civil action against a qui tam defendant through any alternative remedy available to the secretary or the attorney general. If an alternate remedy is pursued in another proceeding, the person initiating the action shall have the same rights he would have had if the action had continued in accordance with this Subpart. Any finding of fact or conclusion of law made in the other proceeding that has become final shall be conclusive on all parties to an action in accordance with this Subpart. A finding or conclusion is final if it has been finally determined on appeal, if all delays for the filing of an appeal regarding the finding or conclusion have expired, or if the finding or conclusion is not subject to judicial review.
Acts 1997, No. 1373, §1; Acts 2009, No. 426, §1.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:440.1. Medical Assistance Programs Fraud Detection Fund

RS 46:440.1 - Medical Assistance Programs Fraud Detection Fund
A. The Medical Assistance Programs Fraud Detection Fund, hereafter referred to as the "fund", is created in the state treasury as a special fund. The monies in the fund shall be invested by the state treasurer in the same manner as monies in the state general fund and interest earned on the investment of monies in the fund shall be credited to the fund. All unexpended and unencumbered monies in the fund at the end of each fiscal year shall remain in the fund.
B. After compliance with the requirements of Article VII, Section 9(B) of the Constitution of Louisiana relative to the Bond Security and Redemption Fund, and prior to monies being placed in the state general fund, all monies received by the state pursuant to a civil award granted or settlement under the provisions of this Part, except for the amount to make the medical assistance programs whole, shall be deposited into the fund.
C. Fifty percent of the monies collected and deposited into the fund shall be allocated to the Medicaid Fraud Control Unit within the office of the attorney general.
D. Fifty percent of the monies collected and deposited into the fund shall be allocated to the Louisiana Department of Health to be used solely for Medicaid fraud detection and for the purposes specified in Subsection E of this Section.
E. The monies in the fund shall not be used to replace, displace, or supplant state general funds appropriated for the daily operation of the department or the medical assistance programs and may be appropriated by the legislature for the following purposes only:
(1) To pay costs or expenses incurred by the department or the attorney general relative to an action instituted pursuant to this Part.
(2) To enhance fraud and abuse detection and prevention activities related to the medical assistance programs, including the activities of the task force on coordination of Medicaid fraud detection and prevention initiatives established pursuant to Subpart D-1 of this Part.
(3) To pay rewards for information concerning fraud and abuse as provided in Subpart B of this Part.
(4) To provide a source of revenue for the Medical Assistance Program in the event of a change in federal policy which results in an increase in state participation or a shortfall in state general fund due to a decrease in the official forecast, as defined in R.S. 39:2(30), during a fiscal year.
Acts 1997, No. 1373, §1; Acts 2008, No. 712, §1, eff. July 1, 2009; Acts 2017, No. 420, §1.
NOTE: See R.S. 46:440.8 regarding termination of Subpart on Aug. 1, 2019.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:440.2. Rewards for fraud and abuse information

RS 46:440.2 - Rewards for fraud and abuse information
A. The secretary may provide a reward of up to two thousand dollars to an individual who submits information to the secretary which results in recovery pursuant to the provisions of this Part, provided such individual is not himself subject to recovery under this Part.
B. The secretary shall grant rewards only to the extent monies are appropriated for this purpose from the Medical Assistance Programs Fraud Detection Fund. The secretary shall determine the amount of a reward, not to exceed two thousand dollars per individual per action, and establish a process to grant the reward in accordance with rules and regulations promulgated in accordance with the Administrative Procedure Act.
Acts 1997, No. 1373, §1.
NOTE: See R.S. 46:440.8 regarding termination of Subpart on Aug. 1, 2019.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:440.3. Whistleblower protection and cause of action

RS 46:440.3 - Whistleblower protection and cause of action
A. No employee shall be discharged, demoted, suspended, threatened, harassed, or discriminated against in any manner in the terms and conditions of his employment because of any lawful act engaged in by the employee or on behalf of the employee in furtherance of any action taken pursuant to this Part in regard to a health care provider or other person from whom recovery is or could be sought. Such an employee may seek any and all relief for his injury to which he is entitled under state or federal law.
B. No individual shall be threatened, harassed, or discriminated against in any manner by a health care provider or other person because of any lawful act engaged in by the individual or on behalf of the individual in furtherance of any action taken pursuant to this Part in regard to a health care provider or other person from whom recovery is or could be sought except that a health care provider may arrange for a recipient to receive goods, services, or supplies from another health care provider if the recipient agrees and the arrangement is approved by the secretary. Such an individual may seek any and all relief for his injury to which he is entitled under state or federal law.
C.(1) An employee of a private entity may bring his action for relief against his employer or the health care provider in the same court as the action or actions were brought pursuant to this Part or as part of an action brought pursuant to this Part.
(2) A person aggrieved of a violation of Subsection A or B of this Section shall be entitled to exemplary damages.
D. A qui tam plaintiff shall not be entitled to recovery pursuant to this Section if the court finds that the qui tam plaintiff instituted or proceeded with an action that was frivolous, vexatious, or harassing.
Acts 1997, No. 1373, §1.
NOTE: See R.S. 46:440.8 regarding termination of Subpart on Aug. 1, 2019.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:440.11. Legislative findings; declaration; purpose

RS 46:440.11 - Legislative findings; declaration; purpose
A. The legislature hereby finds all of the following:
(1) States are required to implement provisions of the Patient Protection and Affordable Care Act, comprised of Public Laws 111-148 and 111-152, relative to Medicaid recovery audit contractors.
(2) The recovery audit function is a useful tool for improving Medicaid program integrity and ensuring that public monies are used for appropriate and necessary healthcare services.
(3) Healthcare providers are subject to numerous audits from the state and federal health agencies and reviews by Medicaid managed care companies which result in increased administrative costs that raise costs to all healthcare consumers.
B. The legislature hereby declares that simplifying and standardizing Medicaid recovery audit functions is necessary and in the best interest of this state. Therefore, the purpose of this Subpart is to provide for greater Medicaid program integrity by establishing a standardized recovery audit contractor program.
Acts 2014, No. 568, §1, eff. Aug. 15, 2014.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:440.12. Definitions

RS 46:440.12 - Definitions
As used in this Subpart, the following terms have the meaning ascribed in this Section:
(1) "Adverse determination" means any decision rendered by the recovery audit contractor that results in a payment to a provider for a claim or service being reduced either partially or completely.
(2) "Contractor" and "recovery audit contractor" mean a Medicaid recovery audit contractor selected by the department to perform audits for the purpose of ensuring Medicaid program integrity in accordance with the provisions of 42 CFR 455 et seq.
(3) "Department" means the Louisiana Department of Health.
(4) "Medicaid" and "medical assistance program" mean the medical assistance program provided for in Title XIX of the Social Security Act.
(5) "Provider" means any healthcare entity enrolled with the department as a provider in the Medicaid program.
Acts 2014, No. 568, §1, eff. Aug. 15, 2014.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:440.13. Recovery audit contractor program established; rulemaking

RS 46:440.13 - Recovery audit contractor program established; rulemaking
A. There is hereby established within the department a recovery audit contractor program. The program shall adhere to the requirements provided in this Subpart.
B. The department shall promulgate all rules in accordance with the Administrative Procedure Act and shall submit all Medicaid state plan amendments as are necessary to implement the provisions of this Subpart.
Acts 2014, No. 568, §1, eff. Aug. 15, 2014.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:440.15. Healthcare provider appeals process

RS 46:440.15 - Healthcare provider appeals process
A. A provider shall have a right to the informal and formal appeals processes for determinations made by the recovery audit contractor as provided in this Section.
B. The contractor shall establish an informal appeals process that conforms with all of the following guidelines:
(1) From the date of receipt of the initial findings letter by the contractor, there shall be an informal discussion and consultation period wherein the provider and contractor may communicate regarding any determinations for reasons including but not limited to policies, criteria, and program rules pertinent to the determination.
(2)(a) Within forty-five days of receipt of a notification of an adverse determination from the contractor, a provider shall have the right to request an informal hearing of such findings, or a portion thereof, with the contractor and the Medicaid program integrity division of the department by submitting a request in writing to the contractor.
(b) The informal hearing provided for in this Paragraph shall occur within thirty days of the provider's request.
(c) At the informal hearing, the provider shall have all of the following rights:
(i) The right to present information orally and in writing.
(ii) The right to present documents.
(iii) The right to have the department and the contractor address any inquiry the provider may make concerning the reason for the adverse determination.
(d) A provider may be represented by an attorney or authorized representative at the informal hearing if written notice of representation identifying the attorney or representative is submitted with the request for the informal hearing.
(3) The contractor and medical assistance program integrity division of the department shall issue a final decision related to the informal appeal to the provider within fifteen days of the closure of the appeal.
C. Within thirty days of the issuance of a final decision or determination pursuant to an informal appeal conducted in accordance with Subsection B of this Section, a provider may request an administrative appeal of the final decision by requesting a hearing before the health and hospitals section of the division of administrative law and providing a copy of the appeal to the Medicaid program integrity division of the department.
Acts 2014, No. 568, §1, eff. Aug. 15, 2014.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:440.16. Contractor performance oversight; penalties; protections

RS 46:440.16 - Contractor performance oversight; penalties; protections
A. If more than twenty-five percent of the contractor's adverse determinations are overturned on appeal in any six-month period, then the House Committee on Health and Welfare and the Senate Committee on Health and Welfare, jointly, shall hold an oversight hearing to evaluate the contractor's performance and provide the medical assistance program with direction related to corrective action plans and future reevaluation of performance.
B. The department shall, with input from healthcare providers and in accordance with the Administrative Procedure Act, promulgate rules relative to appropriate and inappropriate determinations by recovery audit contractors, and to establish penalties and sanctions to be associated with inappropriate determinations by those contractors.
C. If the department or the hearing officer in a formal appeal finds that the recovery audit contractor's determination was unreasonable, frivolous, or without merit, then the contractor shall reimburse to the provider the provider's costs associated with the appeals process.
Acts 2014, No. 568, §1, eff. Aug. 15, 2014.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:441. Surviving spouse of public assistance recipients; retention of benefits received during month of death

RS 46:441 - Surviving spouse of public assistance recipients; retention of benefits received during month of death
A surviving spouse of a general assistance recipient is hereby authorized to receive and retain any financial assistance paid by the Department of Children and Family Services to or for the benefit of said recipient during the month of the death of said recipient, whether or not the check covering such assistance was actually received prior to the death of the recipient.
Acts 1962, No. 97, §1. Amended by Acts 1974, No. 670, §1; Acts 1978, No. 786, §6, eff. July 17, 1978.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:442. Medicaid provider claims; period for filing

RS 46:442 - Medicaid provider claims; period for filing
A. In administering the Medicaid program of this state, the Louisiana Department of Health shall not limit the period within which a healthcare provider may submit a claim for payment for a covered service rendered to a Medicaid program enrollee to less than three hundred sixty-five days from the date the service was provided.
B. In accordance with the applicable provisions of this Part and Part VI-A of this Chapter, if a payment for a claim is recouped by the department, a contractor of the department, or any other entity acting at the direction or under the authority of the department due to a determination by the department more than three hundred sixty-five days from the date the service was provided that the claim was improperly billed but the services were reasonable and necessary, the department shall ensure that the provider is afforded additional time to re-file a corrected claim for that portion of the amount recouped to the extent permitted by federal law.
Acts 2015, No. 21, §1; Acts 2016, No. 467, §1.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:443. Exemption of income and resources

RS 46:443 - Exemption of income and resources
The secretary of the Department of Children and Family Services and the secretary of the Louisiana Department of Health are hereby authorized to adopt income and resources exemption policies to the extent necessary to conform with the federal Economic Opportunity Act, any social security provision, and any other laws of congress to obtain federal block grant or matching funds for the state's public assistance program. Such income and resources exemption policies shall prevail in the event they conflict with R.S. 46:151, 153, 154, and 233.
Added by Acts 1965, No. 19, §1. Amended by Acts 1978, No. 786, §6, eff. July 17, 1978; Acts 1997, No. 1155, §1, eff. July 1, 1997.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:444. Cooperation with administrative agencies relative to interchange of information

RS 46:444 - Cooperation with administrative agencies relative to interchange of information
The Department of Children and Family Services is hereby authorized to provide for interchange of such information necessary in providing for work training experiences as required by Public Law 90-248, as the secretary of the United States Department of Health, Education and Welfare, or its successor department, may require for federal matching purposes.
Added by Acts 1968, No. 167, §1. Amended by Acts 1978, No. 786, §6, eff. July 17, 1978; Acts 2018, No. 206, §5.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:445. Minor emancipated by marriage; nursing care benefits

RS 46:445 - Minor emancipated by marriage; nursing care benefits
A minor emancipated by marriage shall not be ineligible, by reason of age alone, to apply for and receive nursing care benefits.
Added by Acts 1970, No. 347, §1.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:446.1. Notice to department by insurance companies; payment of assigned claims; civil penalties

RS 46:446.1 - Notice to department by insurance companies; payment of assigned claims; civil penalties
A.(1) Every person or entity authorized to issue a hospital or medical service contract or any insurance contract in the state of Louisiana, shall provide notice to the Louisiana Department of Health not later than thirty days prior to payment of any insurance claim, when such claim is clearly identified for services provided in a state facility or by a Medicaid provider pursuant to rules and regulations established by the secretary of the Louisiana Department of Health. Such notice is required so that the department may determine if any portion of such claims is duly payable to the state of Louisiana for services provided by the department to the insured and on whose behalf the state of Louisiana may be entitled to receive insurance benefits.
(2) Contracts subject to such notice provisions shall include but are not limited to employee welfare benefit plans, health and accident insurance policies, including liability and uninsured motorist provisions, group insurance plans, self insurance plans, and the Louisiana State Employees Uniform Group Benefits Program.
B. Information provided pursuant to Subsection A of this Section shall be confidential and subject to the provisions of R.S. 46:56.
C. Upon notification by the department that all or any portion of such claims reported is duly payable to the state or a Medicaid provider, or subject to an assignment of benefits under R.S. 46:153(E), or subject to recovery under R.S. 46:446, payment shall be made to the department or Medicaid provider and the insured notified that payment of the claims has been assigned by the state of Louisiana for services rendered in a state facility or by a Medicaid provider.
D. Any person or entity who fails to provide required notification and assignment of benefits for any claim pursuant to this Section shall be liable for payment to the Louisiana Department of Health for any amounts which would otherwise have been paid under assignment. In addition, such person or entity shall be subject to civil penalties of ten percent of the amounts so payable, such penalties not to exceed five hundred dollars.
E. The penalties assessed by R.S. 22:1821 for failure to make timely payment of benefits shall not apply if the delay in such payment occurs as a result of compliance with the provisions of this Section.
Acts 1988, No. 697, §1, eff. July 15, 1988; Acts 2008, No. 415, §2, eff. Jan. 1, 2009; Acts 2018, No. 206, §5.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:446.2. Third-party liability; acquisition of rights

RS 46:446.2 - Third-party liability; acquisition of rights
A. For purposes of R.S. 46:446.2 through 446.5, "third party" shall mean health and accident insurers, group health plans as defined in §607(1) of the Employee Retirement Income Security Act of 1974, service benefit plans, hospital and medical service plans, health maintenance organizations, limited benefit health insurers, group blanket and franchise insurers, and state employee group benefits plan.
B. For purposes of R.S. 46:446.2 through 446.5, "department" shall mean the Louisiana Department of Health.
C. The state, through the department shall:
(1) Undertake all reasonable measures to ascertain the legal liability of third parties, including the collection of sufficient information to enable the department to pursue claims against such third parties. This information shall be collected at the time of any determination or redetermination of eligibility for Medicaid.
(2) Seek reimbursement for such assistance to the extent of such legal liability in any case where such a legal liability is found to exist after medical assistance has been made available on behalf of the individual and where the amount of reimbursement the department can reasonably expect to recover exceeds the cost of such recovery.
D. To the extent that payment for covered expenses has been made by Medicaid for health care items or services furnished to an individual, in any case where a third party has a legal liability to make payments, the state is deemed to have acquired the rights of the individual to payment by any other party for those health care items or services.
Acts 1995, No. 616, §1.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:446.3. Prenatal or preventive pediatric care; payment and reimbursement

RS 46:446.3 - Prenatal or preventive pediatric care; payment and reimbursement
In the case of prenatal or preventive pediatric care including early and periodic screening and diagnosis services paid by Medicaid, the department shall:
(1) Make payment for such service in accordance with the usual payment schedule for such services without regard to the liability of a third party for payment for such services.
(2) Seek reimbursement from such third party in accordance with R.S. 46:446.2(C)(2).
Acts 1995, No. 616, §1.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:446.4. Payment for dependent children; reimbursement

RS 46:446.4 - Payment for dependent children; reimbursement
In the case of any services covered by Medicaid which are provided to an individual on whose behalf child support enforcement is being carried out by the state, the department shall:
(1) Make payment for such service in accordance with the usual payment schedule under Medicaid for such services without regard to any third-party liability for payment for such services, if such third-party liability is derived through insurance or otherwise from the parent whose obligation to pay support is being enforced by such agency, if payment has not been made by such third party within thirty days after such services are furnished.
(2) Seek reimbursement from such third party in accordance with R.S. 46:446.2(C)(2).
Acts 1995, No. 616, §1.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:446.5. Participating providers; furnishing of services; collection of fees

RS 46:446.5 - Participating providers; furnishing of services; collection of fees
A. A person who furnishes services and is participating as a provider in the Medicaid program may not refuse to furnish services to an individual who is entitled to have payment made by Medicaid for the services the person furnishes because of a third party's potential liability for payment of the service.
B. In the case of an individual who is entitled to Medicaid with respect to a service for which a third party is liable for payment, the person furnishing the service may not seek to collect from the individual or any financially responsible relative or representative for that individual payment of an amount for that service if:
(1) The total of the amount of the liability of third parties for that service is at least equal to the amount payable for that service under Medicaid disregarding 42 U.S.C. 1396(o).
(2) The amount which exceeds the lesser of the amount which may be collected under Medicaid pursuant to 42 U.S.C. 1396(o) or the amount by which the amount payable for that service under Medicaid disregarding 42 U.S.C. 1396(o) exceeds the total of the amount of the liabilities of third parties for that service.
Acts 1995, No. 616, §1.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:447. Revision of standard of need; aid to families with dependent children; general assistance

RS 46:447 - Revision of standard of need; aid to families with dependent children; general assistance
A. The Louisiana Department of Health and the Department of Children and Family Services jointly shall revise the standard of need for the Family Independence Temporary Assistance Program and the general assistance program each year, basing such standard on the Annual Update of the Poverty Income Guidelines published by the United States Department of Health and Human Services. The standard shall reflect the higher of the southern and national averages. The departments shall cause such revised standard to become effective on January first of each year.
B. Implementation of this provision shall be contingent on the Louisiana Department of Health and the Department of Children and Family Services certifying to the commissioner of the division of administration that the revision will not increase the total state dollar expenditure for the two departments.
Acts 1989, No. 722, §1.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:447.3. In-hospital mental health care for adopted children; state's duty to furnish

RS 46:447.3 - In-hospital mental health care for adopted children; state's duty to furnish
To the extent funds are appropriated by the legislature for such purpose, in all adoption subsidy agreements executed after September 1, 2001, involving a child in the custody of the Department of Children and Family Services, the state shall agree to provide acutely medically necessary in-hospital mental health treatment for that child until he reaches the age of majority, provided that the child is not eligible for, or has otherwise exhausted benefits under Medicaid, LaCHIP, or any contract of health and accident insurance or any health benefit plan. The burden of providing the appropriate documentation of the child's eligibility for medical benefits under this statute shall be upon the adoptive parents.
Acts 2001, No. 981, §1.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:448. Emergency assistance information and referral

RS 46:448 - Emergency assistance information and referral
A. As used in this Section:
(1) "Office of children and family services" shall mean the office of children and family services, Department of Children and Family Services, state of Louisiana.
(2) "Emergency assistance" shall mean any service, food, clothing, shelter, money grant, or any other assistance available to people who find their ability to obtain the necessities of life threatened by fire, flood, death, or other sudden and necessitous circumstances.
(3) "Governmental agency" shall mean any political subdivision department, office, agency, board, corporation, or other instrumentality funded in whole or in part by local, state, or federal funds that provides some form of emergency assistance in this state.
(4) "Private agency" shall mean any department, office, agency, board, corporation, or other instrumentality that provides some form of emergency assistance in this state, but shall not include any private agency that chooses not to take referrals or discriminates in their assistance on the grounds of race.
B. The office of children and family services shall gather through its local offices information on all governmental and private agencies in each parish as to the type of assistance each agency can and will provide and as to what eligibility requirements, if any, these agencies apply to their assistance.
C. The office of children and family services shall designate an office in each parish which will aid people seeking emergency assistance, either in person or by telephone, to identify what assistance, if any, the person can obtain. The office of children and family services shall publicize in each parish the availability of this information.
D. Each office will report at the end of each calendar year to the assistant secretary of the office of children and family services, the total number and type of emergency assistance requests it has received and the number and type of emergency assistance requests for which no agency provides assistance in that area. The reports shall be available to the public on request.
E. The services provided pursuant to this Section shall be funded from such monies as are already provided for the office of children and family services, and to this end, shall be deemed not to require additional personnel or appropriations.
Added by Acts 1979, No. 695, §1; Acts 2013, No. 220, §20, eff. June 11, 2013; Acts 2014, No. 791, §17.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:449. Family responsibility program

RS 46:449 - Family responsibility program
A. For purposes of this Section, the following terms shall have the following meanings unless the context clearly indicates otherwise:
(1) "Department" shall mean the Louisiana Department of Health.
(2) "Recipient" shall mean any person receiving intermediate or skilled nursing care in the state of Louisiana and whose income and resources are insufficient to meet the costs of such care.
B. The department is hereby authorized to develop and implement a program of voluntary family responsibility which will recognize those alimentary obligations created by Civil Code Art. 229 et seq.
C. The department is authorized to enter into written agreements with the responsible relatives of recipients whereby such responsible relatives voluntarily agree to contribute to the cost of providing skilled or intermediate nursing care to any recipient who is a relative of such responsible party. Any funds paid pursuant to this provision shall be paid directly to the recipient or to the health care facility for the use and benefit of the designated recipient. Such funds shall first be applied to the personal needs and then to the medical needs of the recipient.
D. The secretary of the department shall have the authority to promulgate rules and regulations necessary to administer the provisions of this Section. All such regulations shall be subject to the provisions of the Administrative Procedure Act.
E. Repealed by Acts 2019, No. 202, §2, eff. June 11, 2019.
Added by Acts 1983, No. 672, §1, eff. for taxable periods beginning after Dec. 31, 1982; Acts 2003, No. 420, §1, eff. June 18, 2003; Acts 2019, No. 202, §§1, 2, eff. June 11, 2019.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:450. WIC Program; authorized vendor participation

RS 46:450 - WIC Program; authorized vendor participation
A. Notwithstanding any other state laws or any rules or regulations promulgated by the Department of Children and Family Services, no applicant shall be prohibited from participating in the WIC Program as an authorized vendor based on:
(1) The location of the proposed retail food outlet unless the proposed retail food outlet is located less than one-fourth mile from another authorized vendor's retail food outlet.
(2) The price of the food package offered is below the median price charged by other vendors in that parish if the price of the food package offered by the authorized vendor is not more than ten percent above the authorized vendor's cost.
B. For purposes of this Section, the following terms shall have the following meanings:
(1) "WIC" means supplemental food and health program for pregnant, breastfeeding, or postpartum women, for up to six months; infants from birth to one year of age; and children, from one year of age to five years of age.
(2) "Vendor" means the owner and employees of any retail food outlet.
Acts 1987, No. 374, §1.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:450.3. WIC participants; homeless

RS 46:450.3 - WIC participants; homeless
A. The office of public health within the Louisiana Department of Health shall adopt rules and regulations for the WIC program in accordance with the Administrative Procedure Act to provide nonperishable food items to women and children. Such rules shall provide for the distribution of WIC vouchers, in small quantities on a frequent basis, for food items that do not require refrigeration or storage to eligible WIC participants that have been identified by qualified organizations as being homeless. Such rules shall comply with requirements of federal laws and regulations in order to ensure receipt of federal funding for the program.
B. In accordance with the provisions of Subsection A of this Section, the following conditions shall apply:
(1) Participants shall receive vouchers weekly for quantities that may be consumed in such a time frame.
(2) Vouchers for such participants shall be redeemable for nonperishable food items, in accordance with state and federal law, if the participant does not have access to refrigeration or adequate storage.
(3) Only eligible WIC participants who have been identified by qualified organizations as homeless shall receive vouchers as provided in Paragraphs (1) and (2).
C. For purposes of this Section, the following terms shall have the following meanings:
(1) "Nonperishable food items" means food items that are not liable to spoil or decay, including but not limited to powdered food substances and freeze-dried food items.
(2) "Qualified organization" means any organization, association, corporation, coalition, confederation, company, business, alliance, establishment, enterprise, firm, club, league, lodge, order, fellowship, fraternity, brotherhood, union, society, group, governmental entity, or other similar body that has met the requirements set forth in rules of the Louisiana Department of Health for proper registration with the vital records registry as an organization which may confirm the identity of displaced persons.
Acts 1993, No. 318, §1, eff. Jan. 1, 1994; Acts 2018, No. 206, §5; Acts 2022, No. 271, §5.
{{NOTE: SEE ACTS 1993, NO. 318, §2.}}
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:450.5. Chronic kidney disease; evaluation; classification; criteria; healthcare coverage

RS 46:450.5 - Chronic kidney disease; evaluation; classification; criteria; healthcare coverage
A. Any enrollee in Medicaid who is eligible for services and who has a diagnosis of diabetes or hypertension, or who has a family history of kidney disease, shall be evaluated for kidney disease through routine clinical laboratory assessments of kidney function.
B. Any enrollee in Medicaid who is eligible for services and who has been diagnosed with diabetes or hypertension or who has a family history of kidney disease, and who has received a diagnosis of kidney disease, shall be classified as a chronic kidney patient.
C. The diagnostic criteria that define chronic kidney disease should be generally recognized clinical practice guidelines which identify chronic kidney disease or its complications based on the presence of kidney damage and level of kidney function.
D. In keeping with the Medicaid disease management program of the Louisiana Department of Health, patients receiving Medicaid benefits who are at risk for chronic kidney disease will be tracked regarding appropriate diagnostic testing. Medicaid providers will be educated and disease management strategies implemented in order to increase the rate of evaluation and treatment for chronic kidney disease according to accepted practice guidelines including:
(1) Managing risk factors, which may prolong kidney function or delay progression to kidney replacement therapy.
(2) Managing risk factors for bone disease and cardiovascular disease associated with chronic kidney disease.
(3) Improving the nutritional status of chronic kidney disease patients.
(4) Correcting anemia associated with chronic kidney disease.
Acts 2005, No. 124, §1; Acts 2022, No. 271, §5.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:450.6. Election of Chafee Option

RS 46:450.6 - Election of Chafee Option
A. To the extent federal financial participation is available pursuant to an approved state Medicaid plan amendment, the Louisiana Department of Health shall exercise its option under 42 U.S.C. 1396a(a)(10)(A)(ii)(XVII) to extend to independent foster care adolescents as defined by 42 U.S.C. 1396d(w)(1) who are not otherwise Medicaid-eligible in accordance with such requirements as were in effect as of April 1, 2008, either of the following types of benefits:
(1) An alternative benefits package authorized by 42 U.S.C. 1396u-7 as set forth in Subsection B of this Section.
(2) Regular Medicaid benefits as provided in the Medical Assistance Plan.
B. For purposes of Subsection A of this Section, the alternative benefits package may include:
(1) A high-deductible private insurance policy.
(2) A health savings account.
(3) A program to educate recipients about health insurance.
C. The department shall have the authority to decide whether to provide either regular Medicaid benefits or the alternative benefits package as set forth in Subsection B of this Section to independent foster care adolescents.
D. The department shall promulgate rules and regulations to define the individual components of the alternative benefits package as set forth in Subsection B of this Section in accordance with the Administrative Procedure Act.
Acts 2008, No. 352, §1; Acts 2022, No. 271, §5.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:450.8. Continuous glucose monitors; Medicaid coverage

RS 46:450.8 - Continuous glucose monitors; Medicaid coverage
A. Except as provided in Subsection B of this Section, the Louisiana Medicaid program shall provide coverage for a continuous glucose monitor for the treatment of an enrollee who has one of the following conditions:
(1) Any type of diabetes with the use of insulin more than two times daily or evidence of level 2 or level 3 hypoglycemia.
(2) Glycogen storage disease type 1a.
B. To qualify for coverage pursuant to Subsection A of this Section, the enrollee shall attend regular follow-up visits with a healthcare provider at a minimum of every six months to assess the ongoing benefit of the enrollee's use of a continuous glucose monitor.
C.(1) The Louisiana Department of Health shall implement the provisions of this Section using the most cost-effective solution available to the department.
(2) The secretary of the department shall submit to the Centers for Medicare and Medicaid Services all state plan amendments, promulgate all rules and regulations in accordance with the Administrative Procedure Act, and take any other actions necessary to implement the provisions of this Section.
D. For the purposes of this Section, "continuous glucose monitor" means an instrument or device, including repair and replacement parts, that is designed and offered for the purpose of measuring glucose levels at set intervals by means of a small electrode placed under the skin and held in place by an adhesive.
Acts 2022, No. 241, §1.