reglab/statecodes huggingface dataset:
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:451. Medicaid reimbursement; midwifery services

RS 46:451 - Medicaid reimbursement; midwifery services
A. The legislature hereby finds and affirms all of the following:
(1) Midwives are community-based practitioners who provide comprehensive, holistic, individualized maternity care and alternative birthing services to low-risk clients.
(2) Midwifery care is family-centered and individualized to consider the unique cultural, ethnic, psychosocial, nutritional, and educational needs of the client and supports healthy lifestyle habits that benefit the whole family.
(3) Midwives have made a tremendous contribution to the health and welfare of mothers, and the practice of midwifery continues to advance as a profession as these providers comprise an increasing part of mainstream health care.
B. The Louisiana Department of Health shall implement a Medicaid reimbursement rate for midwifery services that is, at a minimum, ninety-five percent of the amount reimbursed to licensed physicians for the provision of the same health services in pregnancy and childbirth when acting within their scope of practice.
C. For purposes of this Section, "midwife" means a licensed midwife licensed by the Louisiana State Board of Medical Examiners pursuant to R.S. 37:3240 et seq. or a certified nurse midwife licensed by the Louisiana State Board of Nursing pursuant to R.S. 37:913.
D.(1) The midwife shall be enrolled as a Medicaid provider and be a managed care organization network or a fee-for-service provider in the Medicaid program in order to be reimbursed in accordance with this Section.
(2) Implementation of the reimbursement rate provided for in this Section shall be subject to approval by the Centers for Medicare and Medicaid Services.
(3) The Louisiana Department of Health may promulgate any rules as may be necessary to implement the provisions of this Section.
E.(1) Nothing in this Section shall be construed to require a decrease in any reimbursement rate for midwife services that are reimbursed equal to the amount reimbursed to licensed physicians.
(2) Nothing in this Section shall be construed to expand, diminish, or alter the scope of practice of a midwife.
(3) Nothing in this Section shall be construed to require the Medicaid program to cover any specific healthcare service.
Acts 2023, No. 207, §1.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:460.1. Submission of quarterly reports to the legislature

RS 46:460.1 - Submission of quarterly reports to the legislature
The Department of Children and Family Services shall submit copies of the federal quarterly ACF-196 and ACF-696 reports to the House and Senate committees on health and welfare, the House Committee on Appropriations, and the Senate Committee on Finance at the time these reports are submitted to the federal government. Upon request, the department shall submit copies of any other report the legislature deems necessary.
Acts 2001, No. 918, §1; Acts 2018, No. 206, §5.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:460.3. Adult basic education; literacy training; vocational educational training

RS 46:460.3 - Adult basic education; literacy training; vocational educational training
To the extent allowed by federal law and notwithstanding any other state law, rule, or regulation to the contrary, adult basic education and literacy training shall be included in the definition of vocational educational training for purposes of calculating work participation rates under the Temporary Assistance for Needy Families programs. This law shall apply to any person receiving such education or training, regardless of the person's age.
Acts 2001, No. 926, §1; Acts 2022, No. 271, §5.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:460.4. Educational opportunities to promote self-sufficiency

RS 46:460.4 - Educational opportunities to promote self-sufficiency
A. The legislature hereby finds that an employment-focused program has succeeded in reducing welfare rolls by focusing on the importance of work as a way of escaping poverty; education and employment can give welfare recipients the literacy, knowledge, and aptitudes to obtain and retain private career-path employment; that these programs retain their importance in reducing welfare dependency; that new federal legislation places an increased emphasis on employment and allows the combining of employment-related activities with educational activities; and that to the extent that they can be funded under the new federal welfare reform program without hindering the other federally recognized goals, they should be funded.
B. Repealed by Acts 2003, No. 58, §2.
C. Within this Section, "educational activities" refers to the following educational activities funded by the Department of Children and Family Services in the state 1995-96 Fiscal Year, but not countable towards the federal participation requirements of 42 U.S.C. 407 as amended in 1996:
(1) Courses for obtaining general equivalency degrees.
(2) Adult basic education and literacy training.
(3) Vocational-technical training.
D. The department shall report to the Senate and House committees on health and welfare on or before August 15, 1997, and quarterly thereafter, regarding implementation of the provisions of this Section and to what extent the investment level shall be reached for the fiscal year.
E.(1) The provisions of this Section shall apply only to the extent permissible from federal TANF funds and uncommitted maintenance of effort funds the state is required to spend under TANF.
(2) The provisions of this Section shall also apply only to the extent that TANF and maintenance of effort funds are available and uncommitted for expenditure for other purposes by the department or by the legislature.
(3) Funds that have been received from the federal government shall be considered available and uncommitted provided the requisite approval for the expenditure of such funds under the provisions of R.S. 39:131 et seq. has not been obtained.
F. Nothing in this Section shall prohibit the legislature from appropriating state funds for the educational activities defined in this Section.
Acts 1997, No. 700, §1, eff. July 1, 1997; Acts 2003, No. 58, §§1 and 2; Acts 2018, No. 206, §5.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:460.5. Earned income disregards for certain TANF recipients

RS 46:460.5 - Earned income disregards for certain TANF recipients
A. In order to promote self-sufficiency, the Department of Children and Family Services shall disregard a recipient's first six months of earnings up to nine hundred dollars of gross earnings per month in determining the amount of his household's benefit under Temporary Assistance for Needy Families, provided that such recipient is engaged in a work activity which has been approved by the department as part of his work participation requirement under TANF.
B. This provision shall apply to a household only one time.
C. Months in which a recipient receives the statutory earned income disregard pursuant to Subsection A of this Section shall not count toward the state twenty-four-month limit provided in R.S. 46:231.6(A)(1).
D. For purposes of this Section, "Temporary Assistance for Needy Families" or "TANF" means the federal block grant program established under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, Public Law 104-193.
E. The department shall promulgate rules and regulations to implement the provisions of the earned income disregard program provided in Subsection A of this Section, in accordance with the Administrative Procedure Act.
Acts 1997, No. 733, §1, eff. July 1, 1997; Acts 1997, No. 859, §1, eff. July 10, 1997; Acts 1999, No. 572, §1, eff. July 1, 1999; Acts 2003, No. 58, §1; Acts 2004, No. 675, §1.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:460.6. Individual development account

RS 46:460.6 - Individual development account
A. For purposes of this Section, "individual development account" shall mean a financial account to be used for the purposes specified in this Section and established in the name of an individual account holder who is eligible for the individual development account program based on established income eligibility determination.
B. Notwithstanding any other provision of law to the contrary, a recipient may still receive TANF benefits while maintaining an individual development account which meets the following criteria:
(1)(a) Deposits shall only be made by the individual account holder, a nonprofit organization, an individual contributor, or the state on behalf of the individual.
(b) Total deposits into an individual development account over the life of the account shall not exceed six thousand dollars excluding interest.
(2) At any point in time, the balance of an individual development account shall not exceed six thousand dollars.
(3) The account holder may withdraw monies from an individual development account for the following purposes only:
(a) To pay his educational expenses incurred at an accredited institution of higher education.
(b) To pay his training costs incurred for a training program approved by the department.
(c) To pay for work-related clothing, tools, or equipment as approved by the department.
(d) For homeownership.
(e) For business capitalization.
(4) TANF monies may be deposited into this account, including but not limited to any matching funds that may be appropriated for that purpose.
C. The department shall ensure that there is a limitation of one individual development account per household.
D. An individual account holder who ceases to receive TANF program benefits may withdraw deposited monies from an individual development account for any purpose, except that the individual account holder shall comply with any restriction on the use of any monies deposited by a nonprofit organization or an individual contributor, or on the use of any state matching funds.
E. The department shall promulgate rules and regulations in accordance with the Administrative Procedure Act to implement the provisions of this Section which shall include but not be limited to the following:
(1) The establishment and administration of the individual development account program.
(2) The criteria a nonprofit organization or an individual contributor shall satisfy before making a deposit to an individual development account.
(3) Penalties for fraud or abuse of any provision of this Section.
F. The department may administer an individual development account program as provided in this Section contingent upon the availability of funding to do so.
Acts 1997, No. 881, §1; Acts 2001, No. 1098, §1; Acts 2002, 1st Ex. Sess., No. 84, §1, eff. April 18, 2002; Acts 2013, No. 285, §1, eff. June 14, 2013.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:460.7. Incentive Award Program; dropout reduction; teen pregnancy reduction

RS 46:460.7 - Incentive Award Program; dropout reduction; teen pregnancy reduction
A. The Department of Children and Family Services in consultation with the Department of Education shall develop and implement a special program, the Incentive Award Program, whereby the governing authority of a parish and a parish school system may receive a financial award for reducing the teen pregnancy rate and dropout rate for the parish.
B. The department, in developing this program, shall:
(1) Develop and define the standards to be used to measure progress.
(2) Develop the procedure to be used to collect relevant data to be used to determine progress.
(3) Require that the data collected be compiled into an annual progress report which ranks each parish relative to the progress made by the parish in the relevant categories and provide for the delivery of said report to each school, parish governing authority, and parish school system in the state.
(4) Provide for the annual identification of at least ten parishes which have made the most significant progress in the past year and which will be eligible for the financial award.
C. Through the Incentive Award Program, the department shall provide a financial award to each of the ten parishes identified in the annual progress report which have demonstrated the most significant reduction in dropout rates, as defined by rule of the Department of Education, and in teen pregnancy rates as defined by rule of the Department of Children and Family Services. The financial award shall be distributed to such ten parish school systems. These awards may be expended by the parish school system to implement innovative community-based and school-based programs designed to further reduce the dropout rate and the teen pregnancy rate for the parish and for instructional enhancement programs.
D. No award shall be granted through the Incentive Award Program until such time as the state of Louisiana receives a financial bonus award from the federal government provided for in the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, which provides for awards to the five states that have demonstrated the largest net decrease in the rate of out-of-wedlock births.
Acts 1997, No. 510, §1.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:460.8. TANF eligibility; teen parent living arrangements; work participation requirements; submission of waiver

RS 46:460.8 - TANF eligibility; teen parent living arrangements; work participation requirements; submission of waiver
A.(1) Any recipient of Temporary Assistance for Needy Families Block Grant (TANF) benefits who is less than eighteen years of age, is not married, and is a custodial parent shall live in an approved adult-supervised living arrangement with his or her child, except when evidence is presented to a caseworker of the Department of Children and Family Services that the teen parent, or his or her child, has been subjected to emotional or physical abuse. If the caseworker determines that the teen parent, or his or her child, has been subjected to the abuse of an adult with whom they are living in a primary relationship and that under the circumstances the teen, and his or her child, would be safer living outside the present adult-supervised living arrangement, then the teen parent and child shall be allowed to live outside such living arrangement temporarily. If the teen parent leaves his or her such living arrangement, the caseworker shall monitor the teen's case no less frequently than once a month and shall assist the teen parent in locating another approved adult-supervised living arrangement, taking into consideration the needs and concerns of the teen parent and child. The teen parent shall be allowed to receive TANF benefits on behalf of himself or herself, and his or her child, while temporarily living outside an adult-supervised living arrangement as provided in this Subsection.
(2) Work-eligible, minor parents with children who have not yet received a high school diploma or equivalency shall attend school or related education classes designed to obtain a high school diploma or its equivalent. School attendance shall be the primary work activity for those minor parents who do not have a high school diploma or equivalency. These expectations shall become part of the recipient's Family Success Agreement. Minor parents who fail to participate in these activities are subject to sanction for non-participation and are considered to be out of compliance with a Family Success Agreement.
B. The secretary of the Department of Children and Family Services may temporarily exempt from the work participation requirements any female who is in a two-parent TANF family who presents sufficient evidence to support a claim that she has been incapable of maintaining a job or regularly reporting to her place of employment because she is a victim of domestic violence and has been forced to move into a shelter or another protective environment outside her home.
C. Repealed by Acts 2013, No. 285, §2, eff. June 14, 2013.
Acts 1997, No. 774, §1; Acts 2003, No. 58, §1; Acts 2013, No. 285, §2, eff. June 14, 2013.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:460.9. Waivers for victims of domestic violence

RS 46:460.9 - Waivers for victims of domestic violence
A. The secretary shall waive, for as long as necessary, pursuant to a determination of good cause, any public assistance program requirement that will create obstacles for a victim of domestic violence to escape a domestic violence situation, including but not limited to time limits on receipt of assistance, work, training or educational requirements, limitations of TANF requirements, residency requirements, and any other program requirements which will create obstacles for such victim to escape violence or penalize that victim for past, present, and potential for abuse. However, a victim of domestic violence shall develop a plan that specifies the necessary actions, goals, and services that may enable the victim to become free of a domestic violence situation. Such plan shall be made a component of the participant's Family Success Agreement.
B. Any information obtained pursuant to this Section regarding a victim of domestic violence shall be used solely for the purposes provided for in Subsection A of this Section or for referral to supportive services and shall not be released to any third party, including a governmental agency unless such agency is authorized to obtain such information by another provision of law.
Acts 1997, No. 1248, §2, eff. July 1, 1997; Acts 2003, No. 58, §1.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:460.11. REPEALED BY ACTS 1991, NO. 958, §3 AND ACTS 1991, NO. 1033, §3.

RS 46:460.11 - REPEALED BY ACTS 1991, NO. 958, §3 AND ACTS 1991, NO. 1033, §3.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:460.31. Definitions

RS 46:460.31 - Definitions
As used in this Part, the following terms have the meaning ascribed to them in this Section unless the context clearly indicates otherwise:
(1) "Department" means the Louisiana Department of Health.
(2) "Managed care organization" shall have the same meaning as provided for that term in 42 CFR 438.2 and shall also mean any entity providing primary care case management services to Medicaid recipients pursuant to a contract with the department.
(3) "Medicaid" and "medical assistance program" mean the medical assistance program provided for in Title XIX of the Social Security Act.
(4) "Prepaid coordinated care network" means a private entity that contracts with the department to provide Medicaid benefits and services to enrollees of the Medicaid managed care program in exchange for a monthly prepaid capitated amount per member.
(5) "Primary care case management" means a system in which an entity contracts with the state to furnish case management services, which include but are not limited to the location, coordination, and monitoring of primary health care service to Medicaid beneficiaries.
(6) "Secretary" means the secretary of the Louisiana Department of Health.
Acts 2013, No. 312, §1, eff. Jan. 1, 2014; Acts 2017, No. 349, §2.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:460.33. Prior authorization form; requirements

RS 46:460.33 - Prior authorization form; requirements
A. There shall be a single uniform prescription drug prior authorization form used by all Medicaid managed care organizations, including any Medicaid managed care organization pharmacy benefit managers. The requirement for a single uniform prescription drug prior authorization form shall not apply to prior authorization of specialty drugs or in cases where electronic prescriptions are utilized. All managed care organizations shall use a single uniform prescription drug prior authorization form, not to exceed two pages, excluding guidelines or instructions, that has been jointly promulgated by the Louisiana Board of Pharmacy and the Louisiana State Board of Medical Examiners in accordance with the Administrative Procedure Act. A Medicaid managed care organization may include organization specific information on the form, including but not limited to the organization's name, address, logo, and other contact information for the organization. A health care provider may submit the prior authorization form electronically if the Medicaid managed care organization allows for submission of the form in this manner.
B. The Louisiana Board of Pharmacy and the Louisiana State Board of Medical Examiners shall promulgate rules and regulations prior to January 1, 2019, that establish the form which shall be utilized by all Medicaid managed care organizations. The boards may consult with the health insurance issuers, Medicaid managed care organizations, Louisiana Department of Health, and Department of Insurance as necessary in development of the prior authorization form.
C. Pursuant to its contract with any Medicaid managed care organization, the department shall assess sanctions against any Medicaid managed care organization that directly or through its pharmacy benefit managers, utilizes any prescription drug prior authorization form other than the single uniform prescription drug prior authorization form provided for in this Section.
D. The single uniform prescription drug prior authorization form provided for in this Section shall be the same as provided for in R.S. 22:1006.1.
Acts 2013, No. 312, §1, eff. Jan. 1, 2014; Acts 2018, No. 423, §2, eff. Jan. 1, 2019.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:460.34. Step therapy; fail first protocols; requirements

RS 46:460.34 - Step therapy; fail first protocols; requirements
A. Each managed care organization that utilizes step therapy or fail first protocols shall comply with the provisions of this Section.
B. When medications for the treatment of any medical condition are restricted for use by a managed care organization by a step therapy or fail first protocol, the prescribing physician shall be provided with and have access to a clear and convenient process to expeditiously request an override of such restriction from the managed care organization. The managed care organization shall expeditiously grant an override of such restriction under any of the following circumstances:
(1) The prescribing physician can demonstrate to the managed care organization, based on sound clinical evidence, that the preferred treatment required under step therapy or fail first protocol has been ineffective in the treatment of the Medicaid enrollee's disease or medical condition.
(2) The prescribing physician can demonstrate to the managed care organization, based on sound clinical evidence, that the preferred treatment required under the step therapy or fail first protocol will be expected to be ineffective based on the known relevant physical or mental characteristics and medical history of the Medicaid enrollee and known characteristics of the drug regimen.
(3) The prescribing physician can demonstrate to the managed care organization, based on sound clinical evidence, that the preferred treatment required under the step therapy or fail first protocol will cause or will likely cause an adverse reaction or other physical harm to the Medicaid enrollee.
C. The duration of any step therapy or fail first protocol shall not be longer than the duration of action for the medication as described in the pharmacokinetics section of the package insert approved by the United States Food and Drug Administration when such treatment is demonstrated by the prescribing physician to be clinically ineffective.
Acts 2013, No. 312, §1, eff. Jan. 1, 2014.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:460.35. Exemptions

RS 46:460.35 - Exemptions
The provisions of this Part shall not apply to any entity that contracts with the department to provide fiscal intermediary services in processing claims of health care providers.
Acts 2013, No. 312, §1, eff. Jan. 1, 2014.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:460.36. Pharmacy reimbursement by managed care organizations

RS 46:460.36 - Pharmacy reimbursement by managed care organizations
A. Words and terms used in this Section shall have the following meanings:
(1) "Department" means the Louisiana Department of Health.
(2) "Legacy Medicaid rate" means the lesser of one of the following:
(a) The published Medicaid fee-for-service reimbursement rate for the combination of the ingredient cost and dispensing fee in use for the current approved Medicaid state plan in effect on the date of service.
(b) The usual and customary charge. This charge shall be the price the provider most frequently charges the general public for the same drug unless otherwise defined in the current approved Medicaid state plan in effect on the date of service.
(c) The pharmacy's submitted charge.
(3) "Local pharmacy" means any pharmacy, domiciled in at least one Louisiana parish that meets both of the following criteria:
(a) Contracts with the managed care organization or the managed care organization's contractor in its own name or through a pharmacy services administration organization and not under the authority of a group purchasing organization.
(b) Has fewer than ten retail outlets under its corporate umbrella.
B., C. Repealed by Acts 2017, No. 301, §2, eff. Oct. 1, 2017.
D. No managed care organization shall pay a local pharmacy a per-prescription reimbursement at a rate less than the legacy Medicaid rate.
E. Repealed by Acts 2017, No. 301, §2, eff. Oct. 1, 2017.
Acts 2015, No. 399, §2; Acts 2017, No. 301, §§1, 2, eff. Oct. 1, 2017.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:460.41. Definitions

RS 46:460.41 - Definitions
As used in this Part, the following terms shall have the meaning ascribed to them in this Section unless the context clearly indicates otherwise:
(1) "Department" means the Louisiana Department of Health.
(2) "Health care provider" or "provider" means a physician licensed to practice medicine by the Louisiana State Board of Medical Examiners or other individual health care practitioner licensed, certified, or registered to perform specified health care services consistent with state law.
(3) "Managed care organization" shall have the same meaning as provided for that term in 42 CFR 438.2 and shall also mean any entity providing primary care case management services to Medicaid recipients pursuant to a contract with the department.
(4) "Medicaid" and "medical assistance program" mean the medical assistance program provided for in Title XIX of the Social Security Act.
Acts 2013, No. 311, §1.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:460.42. Claims payment for care rendered to newborns; reporting

RS 46:460.42 - Claims payment for care rendered to newborns; reporting
A. Each managed care organization shall compensate, at a minimum, ninety percent of the Medicaid fee-for-service rate in effect for each service coded as a primary care service rendered to a newborn Medicaid beneficiary within thirty days of the beneficiary's birth regardless of whether the Medicaid provider rendering the services is contracted with the managed care organization, but subject to the same requirements as a contracted provider.
B. On or before January 1, 2014, and annually thereafter, the department shall report to the House and Senate committees on health and welfare the incidence and causes of all re-hospitalizations of infants born premature at less than thirty-seven weeks gestational age and who are within the first six months of life.
Acts 2013, No. 311, §1.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:460.52. Exemptions

RS 46:460.52 - Exemptions
The provisions of this Part shall not apply to any entity contracted with the Louisiana Department of Health to provide fiscal intermediary services in processing claims of the health care providers.
Acts 2013, No. 358, §1, eff. Jan. 1, 2014.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:460.53. Contract amendments; public notice

RS 46:460.53 - Contract amendments; public notice
A. The department, prior to executing any amendment to a professional, personal, consulting, or social services contract that provides for managed care under the Louisiana Medical Assistance Program through the use of a managed care organization, primary care case management, prepaid inpatient health plan, or prepaid ambulatory health plan, all as defined in 42 CFR 438.2, shall publish on a publicly accessible page of the department's website a copy of the entire proposed contract amendment and provide a public comment period of no less than thirty days.
B. If the department finds that an imminent peril to the public health, safety, or welfare requires immediate execution of a proposed contract amendment without otherwise publishing the proposed contract amendment as required in Subsection A of this Section, the department may execute the proposed contract amendment upon publishing a copy of the contract amendment and a written statement that details the reason for finding that an imminent peril to the public health, safety, or welfare requires adoption of the executed amendment.
Acts 2019, No. 319, §1.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:460.54. Medicaid policies and procedures; procedure for adoption; required content

RS 46:460.54 - Medicaid policies and procedures; procedure for adoption; required content
A. The department, prior to adopting, approving, amending, or implementing any policy or procedure, shall publish the proposed policy or procedure on a publicly accessible page of the department's website for a period of no less than forty-five days for the purpose of soliciting public comments. The proposed policy or procedure shall be published in a format to be determined by the department but shall include both the existing policy or procedure and the proposed policy and procedure, with the proposed language in the text printed in boldface type and underscored. All present policy or procedure language and punctuation which are to be deleted shall be struck through.
B. A policy or procedure proposed by a managed care organization shall not be implemented unless the department has provided its express written approval to the managed care organization after the expiration of the public notice period required by this Section.
C. If the department finds that an imminent peril to the public health, safety, or welfare requires immediate approval of a proposed policy or procedure without otherwise publishing the proposed policy or procedure as required in Subsection A of this Section, the department may implement the proposed policy or procedure upon publishing a written statement that details its reason for finding that an imminent peril to the public health, safety, or welfare requires adoption of the proposed policy or procedure and a copy of the policy or procedure.
D. The provisions of this Section shall not apply to any policy or procedure that is otherwise duly promulgated in accordance with the Administrative Procedure Act or included in a duly executed contract amendment.
E. The department or a managed care organization shall be prohibited from enforcing any policy or procedure that is not adopted in compliance with this Section and any such policy or procedure shall be null and void and considered a violation of the public policy of this state.
F. If the managed care organization makes any policy or procedure change, the managed care organization shall submit the changes to the department for approval within the time specified by the department.
G. The department shall include in its Medicaid policies and procedures all of the following information relating to telehealth:
(1) An exhaustive listing of the covered healthcare services which may be furnished through telehealth.
(2) Processes by which providers may submit claims for reimbursement for healthcare services furnished through telehealth.
(3) The conditions under which a managed care organization may reimburse a provider or facility that is not physically located in this state for healthcare services furnished to an enrollee through telehealth.
Acts 2019, No. 319, §1; Acts 2020, No. 88, §2.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:460.63. Physician participation; conditions for termination

RS 46:460.63 - Physician participation; conditions for termination
A. With respect to credentialing of a physician whose license is in probationary status pursuant to action by the Louisiana State Board of Medical Examiners, no managed care organization shall terminate participation by that physician in the organization's provider network based solely upon the probationary status of his license or disqualify the physician from initial credentialing based solely upon the probationary status of his license.
B. No managed care organization shall terminate participation by a physician in the organization's provider network unless such action is taken pursuant to an established credentialing committee procedure.
Acts 2016, No. 250, §1.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:460.70. Timely filing of claims

RS 46:460.70 - Timely filing of claims
In accordance with the provisions of R.S. 46:442, the department shall not limit the period within which a provider may submit a claim for payment for a covered service rendered to an enrollee to less than three hundred sixty-five days from the date the service was provided. This prohibition on limiting the claim submission period to less than three hundred sixty-five days from the date of service shall apply relative to claims submitted directly to the department and to claims submitted to all of the following entities:
(1) A managed care organization.
(2) Any of the following entities as defined in 42 CFR 438.2:
(a) A prepaid ambulatory health plan.
(b) A prepaid inpatient health plan.
(c) A primary care case manager.
Acts 2015, No. 21, §1.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:460.74. Prior authorization; criteria; notice to providers

RS 46:460.74 - Prior authorization; criteria; notice to providers
A. The prior authorization requirements of the department and each managed care organization, including prior authorization requirements applicable in the Medicaid pharmacy program, shall either be furnished to the healthcare provider within twenty-four hours of a request for the requirements or posted in an easily searchable format on the website of the respective managed care organization or the department. Information posted in accordance with the requirements of this Section shall include the date of last review.
B. If the department or a managed care organization denies a prior authorization request, then the department or managed care organization shall provide written notice of the denial to the provider requesting the prior authorization within three business days of making the decision. If the denial of the prior authorization by the department or managed care organization is based upon an interpretation of a law, regulation, policy, procedure, or medical criteria or guideline, then the notice shall contain either instructions for accessing the applicable law, regulation, policy, procedure, or medical criteria or guideline in the public domain or an actual copy of that law, regulation, policy, procedure, or medical criteria or guideline.
Acts 2019, No. 330, §1.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:460.76. Prepayment review

RS 46:460.76 - Prepayment review
A. A managed care organization or a contractor, assignee, agent, or entity acting on the behalf of a managed care organization shall be prohibited from requiring any enrolled provider to be subject to prepayment review unless the requirement is implemented directly by the department and in accordance with the provisions of the Medical Assistance Programs Integrity Law, R.S. 46:437.1 et seq.
B. For the purposes of this Section, "prepayment review" means any action by a managed care organization or a contractor, assignee, agent, or entity acting on the behalf of a managed care organization requiring a healthcare provider to provide medical record documentation in conjunction with or after the submission of a claim for payment for medical services rendered, but before the claim has been adjudicated by the managed care organization.
C.(1) Nothing in this Section shall prohibit a managed care organization from notifying the department of healthcare providers suspected of committing fraud and abuse.
(2) Nothing in this Section shall prohibit the department from requiring all managed care organizations to coordinate efforts to combat and prevent fraud and abuse pursuant to any requirements ordered by the department in accordance with the Medical Assistance Programs Integrity Law, R.S. 46:437.1 et seq.
D. The provisions of this Section shall not apply to any dental coordinated care network as defined in R.S. 46:460.51.
Acts 2022, No. 534, §1.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:460.77.1. Behavioral health services claims; limitation on service hours; information required for payment

RS 46:460.77.1 - Behavioral health services claims; limitation on service hours; information required for payment
A.(1) For purposes of this Section, "CPST services" means community psychiatric support and treatment services and "PSR services" means psychosocial rehabilitation services.
(2) An individual behavioral health services provider rendering CPST services, PSR services, or both shall be limited to a maximum combined total of twelve reimbursable hours of CPST services and PSR services per rendering provider, per calendar day, regardless of the number of patients seen by the rendering provider unless any of the following conditions are met:
(a) The medical necessity of the services is documented for a Medicaid recipient receiving more than twelve hours of CPST and PSR services per day per rendering provider.
(b) The services are billed for a group setting. However, the total hours worked by an individual rendering provider shall not exceed twelve reimbursable hours per calendar day.
(c) The services are billed for crisis intervention.
(3)(a) Services subject to the twelve-hour limitation provided in Paragraph (2) of this Subsection include only CPST and PSR services rendered per individual National Provider Identifier at one or more outpatient behavioral health services provider facilities or agencies within a calendar day.
(b) The twelve-hour limitation provided in Paragraph (2) of this Subsection shall not apply per individual behavioral health services provider agency.
(4)(a) Except as provided in Subparagraph (b) of this Paragraph, the provisions of this Subsection shall apply exclusively to CPST services and PSR services.
(b) The provisions of this Subsection shall not apply to evidence-based practices including, without limitation, the practices known as assertive community treatment, multisystemic therapy, functional therapy, and homebuilders.
B. No managed care organization shall accept for payment a claim from a provider of behavioral health services unless that claim includes all claim information required by R.S. 40:2162.
C. The department shall include the limitation on reimbursable hours of CPST and PSR services provided in Subsection A of this Section in each contract with a managed care organization that covers behavioral health services.
D. Implementation of any provision of this Section shall be subject to approval by the Centers for Medicare and Medicaid Services.
Acts 2019, No. 370, §1.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:460.77.2. Behavioral health services claim information; access by legislative auditor and Medicaid Fraud Control Unit

RS 46:460.77.2 - Behavioral health services claim information; access by legislative auditor and Medicaid Fraud Control Unit
Upon request of the legislative auditor or the Medicaid Fraud Control Unit of the office of the attorney general, the department shall furnish to the requestor behavioral health data that meets the applicable standard for completeness set forth by the Centers for Medicare and Medicaid Services.
Acts 2019, No. 370, §1.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:460.77.3. Staff training requirements

RS 46:460.77.3 - Staff training requirements
A. Employees, contractors, and subcontractors of managed care organizations performing work or services related to the performance or supervision of audits, prior authorization determinations, and clinical reviews of mental health rehabilitation services providers shall receive annual training on Louisiana's Medicaid Behavioral Health Provider Manual and the relevant state laws, policies, and regulations related to the state's mental health rehabilitation program.
B. Employees, contractors, and subcontractors of managed care organizations shall take all necessary steps to ensure mental health rehabilitation services providers are rostered, credentialed, or otherwise eligible to provide and be reimbursed for mental health rehabilitation services in accordance with R.S. 46:460.61.
C. For purposes of this Section, the following definitions apply:
(1) "Mental health rehabilitation" means an outpatient healthcare program provider of any psychosocial rehabilitation, crisis intervention, or community psychiatric support and treatment services that promotes the restoration of community functioning and well-being of an individual diagnosed with a mental health or mental or emotional disorder. A mental health rehabilitation provider uses evidence-based supports and interventions designed to improve individual and community outcomes.
(2) "Mental health rehabilitation services" means outpatient services for adults with serious mental illness and children with emotional or behavioral disorders which are medically necessary to reduce the disability resulting from mental illness and assist in the recovery and resiliency of the recipient. Such services are home- and community-based and are provided on an as-needed basis to assist recipients in coping with the symptoms of their illness. The intent of mental health rehabilitation services is to minimize the disabling effects on the individual's capacity for independent living and to prevent or limit the periods of inpatient treatment.
D. The department shall promulgate in accordance with the Administrative Procedure Act all rules as are necessary to implement the provisions of this Section.
Acts 2021, No. 204, §2, eff. Jan. 1, 2022.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:460.81. Right of providers to independent review; applicability

RS 46:460.81 - Right of providers to independent review; applicability
A. If a provider's claim is subject to an adverse determination evidenced in a remittance advice or other written or electronic notice from a managed care organization, then the provider shall have a right to an independent review of the adverse action taken by the managed care organization. Such independent review shall be governed by the provisions of this Subpart and any applicable rules and regulations promulgated by the department pursuant to the Administrative Procedure Act. The provisions of this Subpart shall not otherwise prohibit or limit any alternative legal or contractual remedy available to a provider to contest the partial or total denial of a claim for payment for healthcare services. Any contractual provision executed between a provider and a managed care organization which seeks to limit or otherwise impede the appeal process as set forth in this Subpart shall be null, void, and deemed to be contrary to the public policy of this state.
B. The provisions of this Subpart shall not apply to any adverse determination associated with a claim filed with a managed care organization prior to January 1, 2018, regardless of whether the claim is re-filed after that date. For all adverse determinations related to claims filed on or after January 1, 2018, the state shall not mandate that the provider and managed care organization resolve the claim payment dispute through arbitration.
C. An adverse determination involved in litigation or arbitration or not associated with a Medicaid enrollee shall not be eligible for independent review under the provisions of this Subpart.
D. Notwithstanding any other provision of law, a mental health rehabilitation services provider shall have the right to an independent review of an adverse determination taken by a managed care organization that results in a recoupment of the payment of a claim based upon a finding of waste or abuse.
Acts 2017, No. 349, §2; Acts 2021, No. 204, §2, eff. Jan. 1, 2022.
2023 Louisiana Laws › Revised Statutes › Title 46 - Public Welfare and Assistance › §46:460.83. Independent review; judicial appeal

RS 46:460.83 - Independent review; judicial appeal
Within sixty calendar days of an independent reviewer's decision, either party to the dispute may file suit in any court having jurisdiction to review the independent reviewer's decision and to recover any funds awarded by the independent reviewer to the other party. Any claim concerning an independent reviewer's decision not brought within sixty calendar days of the decision shall be barred indefinitely. Suits filed pursuant to this Section shall be conducted in accordance with applicable provisions of the Code of Civil Procedure, and the review by the court will be de novo without regard to the independent reviewer's decision. The independent reviewer and any person who assisted the independent reviewer in reaching a decision shall be prohibited from testifying at the court proceeding considering the independent reviewer's decision. Venue shall be proper in the district court for the parish where either the healthcare provider or the managed care organization is domiciled, and the district court for that parish has exclusive jurisdiction thereof. If the dispute between the parties is not fully resolved prior to the entry of a final decision by the court initially hearing the dispute, then the prevailing party shall be entitled to an award of reasonable attorney fees and expenses from the nonprevailing party. For purposes of this Section, "reasonable attorney fees" means the number of hours reasonably expended on the dispute multiplied by a reasonable hourly rate, and shall not exceed ten percent of the total monetary amount in dispute or five hundred dollars, whichever amount is greater.
Acts 2017, No. 349, §2.