By time you read this, we will have ushered in year 2012. There are many public policy issues to watch this year. The Louisiana Department of Health and Hospitals will begin rolling out their Medicaid Managed Care plan in February 2012.

The plan, named Bayou Health, will continue to be implemented statewide. The first area of the state to come on board will be the Greater New Orleans Region. A list of the contact information for the selected Coordinated Care Networks can be found at www.lasbhc.org or on the DHH website www.makingmedicaidbetter.com.

Another initiative to watch will be the mental (or behavioral health) component. Magellan held briefings during December for public interest groups and healthcare providers. For more information on Magellan, shoot me an email and I will send you whatever materials I have on hand (Destiny362@aol.com)

Meanwhile, the Department of Health and Hospitals promulgated the following administrative rules in the November 20th edition of the Louisiana Register.

The following rules were published in the November 20, 2011 Louisiana Register. They are available at www.doa.louisiana.gov/OSR/reg/regs2011.htm.

If you need further information, please contact me.

EMERGENCY RULES

1.  Federally Qualified Health Centers – Fluoride Varnish Applications:  amends the provisions of the September 20, 2011 Rule to adopt provisions for the coverage of fluoride varnish applications rendered to Medicaid recipients. 

2.  Inpatient Hospitals – Major Teaching Hospitals – Qualifying Criteria: amends the provisions of the July 1, 2010 Emergency Rule governing inpatient hospital services rendered by non-rural, non-state hospitals designated as teaching hospitals to clarify the qualifying criteria for a major teaching hospital.

3.  Personal Care Service – Long Term – Policy Clarification and Service Limit Reduction: amends the provisions of the April 20, 2011 rule in order to bring these provisions in line with current licensing standards.

4.  Professional Services Program – Fluoride Varnish Applications: amends the provisions governing the Professional Services Program in order to establish Medicaid reimbursement for fluoride varnish application services rendered by qualified providers in a physician office setting.

5.  Rural Health Clinics – Fluoride Varnish Applications: amends the September 20, 2011 Rule to adopt provisions for the coverage of fluoride varnish application services rendered to Medicaid recipients.

6.  Standards for Community Mental Health - Physical Space Requirements Exemption: amends the provisions of the April 20, 1987 Rule governing the minimum licensing standards for community mental health centers and mental health clinics in order to allow for state- or district-owned or operated facilities which operate in or with a state- or district-owned or operated substance abuse/addictive disorders facility.

7.  Substance Abuse/Addictive Disorders Facilities – Minimum Licensing Standards - Physical Space Requirements Exemption: amends the provisions of the March 20, 2005 Rule governing the minimum licensing standards for substance abuse/addictive disorders facilities in order to allow for an exemption from the physical space requirements for state- or district-owned or operated facilities which operate in or with a state- or district-owned or operated mental health center or mental health clinic.

REDECLARED EMERGENCY RULES

1.  Adult Day Health Care – Minimum Licensing Standards:  continues the provisions of the April 1, 2011 Emergency Rule, which amended the provisions governing the minimum licensing standards for adult day health care centers to revise and clarify the staffing and transportation requirements.

2.  CommunityCARE Program – Program Redesign:  continues the provisions of the April 20, 2011 Emergency Rule, which amended the Rule governing the CommunityCARE Program in order to redesign the program by amending the provisions governing recipient participation, provider selection, provider qualifications, referrals and authorizations and primary care provider reimbursement.

3.  Direct Services Worker Registry:  continues the provisions of the April 20, 2010 Emergency Rule, which amended the provisions governing the Direct Services Worker (DSW) Registry in order to create a more manageable and efficient DSW process.

4.  Early and Periodic Screening, Diagnosis and Treatment – Substance Abuse Services:  continues the provisions of the April 22, 2011 Emergency Rule, which adopted the provisions governing Medicaid coverage of substance abuse services covered under the Early and Periodic Screening, Diagnosis and Treatment Program.

5.  Inpatient Hospital Services – Small Rural Hospitals – Upper Payment Limit:  continues the provisions of the August 1, 2010 Emergency Rule, which amended the provisions governing the reimbursement methodology for small rural hospitals to reimburse inpatient hospital services up to the Medicare inpatient upper payment limits. 

6.  Intermediate Care Facilities for Persons with Developmental Disabilities – Non-State Facilities – Reimbursement Methodology:  continues the provisions of the August 1, 2010 Emergency Rule, which amended the provisions governing the reimbursement methodology for non-state intermediate care facilities for persons with developmental disabilities to restore the per diem rates paid to private providers who have downsized large facilities to less than 35 beds and incurred unusually high capital costs as a result of the downsizing.

7.  Outpatient Hospital Services – Small Rural Hospitals – Upper Payment Limit:  continues the provisions of the August 1, 2010 Emergency Rule, which amended the provisions governing the reimbursement methodology for small rural hospitals to reimburse outpatient hospital services up to the Medicare outpatient upper payment limits.

8.  Pregnant Women Extended Services – Substance Abuse Screening and Intervention Services: continues the provisions of the April 1, 2011 Emergency Rule which adopted  provisions to provide Medicaid coverage of substance abuse screening and brief interventions rendered to Medicaid eligible pregnant women. 

NOTICES OF INTENT

1.  Adult Mental Health Services:  adopts provisions to implement a coordinated behavioral health services system under the Louisiana Medicaid Program to provide mental health services to adults with serious and persistent mental illness or co-occurring disorders of mental illness.

2.  Behavioral Health Services – Statewide Management Organization:  adopts provisions to implement a coordinated behavioral health services system under the Louisiana Medicaid Program to provide services through the utilization of a statewide management organization that will be responsible for the necessary administrative and operational functions to ensure adequate coordination and delivery of behavioral health services.

3.  Children’s Mental Health Services:  adopts provisions to implement a coordinated behavioral health services system under the Louisiana Medicaid Program to provide mental health services to children and youth.

4.  Early and Periodic Screening, Diagnosis and Treatment (EPSDT) – Psychological and Behavioral Services and School Based Mental Health Services:  amends the provisions governing the EPSDT Program in order to repeal Chapter 77 governing psychological and behavioral services as these provisions will be revised and repromulgated in Part XXXIII. In addition, the department proposes to amend the provisions governing school based health centers in order to remove any provisions relative to mental health services since these provisions will also be revised and repromulgated in Part XXXIII.

5.  Home and Community-Based Behavioral Health Services Waiver:  adopts provisions to implement a home and community-based services (HCBS) waiver as part of the coordinated behavioral health services system under the Louisiana Medicaid Program. This HCBS waiver will provide behavioral health services to Medicaid eligible children diagnosed with mental illness or a serious emotional disturbance.

6.  Pharmacy Benefits Program – Prescription Time Limits:  amends the provisions of the June 2006 rule to extend the expiration date for certain prescriptions.

7.  Psychiatric Residential Treatment Facilities:  adopts provisions to implement a coordinated behavioral health services system under the Louisiana Medicaid Program to provide inpatient behavioral health services to children with emotional/behavioral disorders in psychiatric residential treatment facilities. 

8.  Psychiatric Residential Treatment Facilities – Minimum Licensing Standards:  amends the provisions governing the minimum licensing standards for psychiatric residential treatment facilities in order to prepare for the transition to a comprehensive system of delivery for behavioral health services in the state.

9.  School Based Behavioral Health Services:  adopts provisions to implement a coordinated behavioral health services system under the Louisiana Medicaid Program to provide school based behavioral health services to children and youth.

10.  Substance Abuse Services:  adopts provisions to implement a coordinated behavioral health services system under the Louisiana Medicaid Program which will now provide coverage of substance abuse services for children and adults. 

11.  Therapeutic Group Homes: adopts provisions to implement a coordinated behavioral health services system under the Louisiana Medicaid Program to provide behavioral health services to children with emotional/behavioral disorders in therapeutic group homes.

12.  Therapeutic Group Homes – Minimum Licensing Standards: adopts provisions governing the minimum licensing standards for therapeutic group homes in order to prepare for the transition to a comprehensive system of delivery for behavioral health services in the state.

FINAL RULES

1.  Facility Need Review - Nursing Facilities:  amends the provisions governing the facility need review process for nursing facilities in order to revise the provisions governing the service area.

2.  Mental Health Rehabilitation Program - Termination of Parent/Family Intervention (Intensive) Services and Reimbursement Rate Reduction:  continues the provisions of the November 20, 2010 and the January 1, 2011 Emergency Rules which amended the provisions governing the Mental Health Rehabilitation (MHR) Program to terminate the coverage of Parent/Family Intervention (Intensive) (PFII) services, amend the provisions governing medical necessity for MHR services in order to establish continued treatment criteria and reduce the reimbursement rates.

3.  Multi-Systemic Therapy - Reimbursement Rate Reduction:  continues the provisions of the November 20, 2010 and the January 1, 2011 Emergency Rules which amended the provisions governing the reimbursement methodology for multi-systemic therapy services to reduce the reimbursement rates.

4.  Outpatient Hospital Services - Non-Rural, Non-State Hospitals and Children’s Specialty Hospitals - Reimbursement Rate Reduction:  continues the provisions of the November 20, 2010 and the January 1, 2011 Emergency Rules which amended the provisions governing the reimbursement methodology for outpatient hospital services to further reduce the reimbursement rates paid to non-rural, non-state hospitals and children’s specialty hospitals.

5.   Personal Care Services-Long-Term - Reimbursement Rate Reduction:  continues the provisions of the August 1, 2010 and April 20, 2011 Emergency Rules which amended the provisions governing the reimbursement methodology for long-term personal care services to reduce the reimbursement rates.

6.  Pharmacy Benefits Management Program - Lock-In Program:  amends the provisions governing the Pharmacy Benefits Management Program in order to revise and clarify the provisions governing the Pharmacy Lock-In Program.

7.  Pharmacy Benefits Management Program - Prescription Limit Reduction:  continues the provisions of the February 1, 2011 Emergency Rule which amended the provisions governing prescription limits in the Pharmacy Benefits Management Program to reduce the number of prescriptions covered by the Medicaid Program from 5 to 4 prescriptions within a calendar month for certain recipients.

8.  Pregnant Women Extended Services - Dental Services - Reimbursement Rate Reduction:  continues the provisions of the November 20, 2010 and the January 1, 2011 Emergency Rules which amended the provisions governing the reimbursement methodology for dental services provided to Medicaid eligible pregnant women in order to reduce the reimbursement rates.

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