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News & Press: Advocacy & Legislative Updates

November Regulatory Update

Tuesday, November 24, 2015   (0 Comments)
Posted by: Sabrina Noah
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The November issue of the Louisiana Register contains several proposed rules which are of interest to our members.  As part of our continued efforts to keep you informed, we have developed the following summaries of the proposed administrative rules.  Please submit any comments or concerns about any of the proposed rules mentioned below to Wes Hataway, LSMS vice president, legal affairs and general counsel at wes@lsms.org prior to the dates designated below each rule discussion.


Potpurri


Board of Nursing

 

The Board of Nursing (“BON”) has announced it will conduct a public hearing on November 30, 2015 at 1 pm.  The hearing is being held at the request of the LSMS as well as the Louisiana Society of Anesthesiologists (“LSA”). 

 

In October, the BON published proposed rules regarding the scope of practice for certified registered nurse anesthetists (“CRNA”) found in LAC 46:XLVII.4513.  Section 4513(11)(c)(i) of the proposed rules state “anesthesia care shall be within the scope of practice of CRNAs as delineated by the American Board of Nurse Anesthetists…”  Further, the proposed rules state in Section 4513(11)(ii)(a) state “ancillary services provided by CRNAs shall include services within the scope of practice of CRNAs as delineated by the American Association of Nurse Anesthetists…”  The LSMS expressed concern in its written comments that the proposed rules would effectively delegate the supervisory and regulatory authority from the BON to an out-of-state based trade organization. 

 

The LSMS will provide an update following the public hearing.

 

Department of Health and Hospitals


On July 30, 2015, the department conducted a public hearing to solicit comments and testimony on a proposed rule regarding the provisions governing managed care for physical and basic behavioral health in order to revise the timely filing requirements for provider claims.  As a result of the comments received, the department proposes to amend the provisions of the proposed rules as follows:

 

Part I. Administration

Subpart 3. Managed Care for Physical and Basic Behavioral Health

Chapter 35. Managed Care Organization Participation Criteria

§3511. Prompt Pay of Claims

A. - B.1.c. ...

2. Medicaid claims must be filed within 365 days of the date of service.

a. The provider may not submit an original claim for payment more than 365 days from the date of service, unless the claim meets one of the following exceptions:

i. the claim is for a member with retroactive Medicaid eligibility and must be filed within 180 days from linkage into an MCO;

ii. the claim is a Medicare claim and shall be submitted within 180 days of Medicare adjudication; and iii. the claim is in compliance with a court order to carry out hearing decisions or agency corrective actions taken to resolve a dispute, or to extend the benefits of a

hearing decision or corrective action.


A public hearing regarding the amendments will be held on December 30, 2015, at 9:30 am. The hearing will take place in Room 118, Bienville Building, 628 North Fourth St., Baton Rouge, LA.  Please send any comments to this proposed rule change to Wes Hataway, Vice President of Legal Affairs, at wes@lsms.org

 

Notice of Intent


Department of Health and Hospitals


Due to a budgetary shortfall in SFY 2013, the Bureau of Health Services amended the provisions governing the reimbursement methodology for inpatient hospital services to reduce reimbursement rates paid to non-rural, not-state hospitals, including children’s specialty hospitals.  The department subsequently promulgated an Emergency Rule which amended the provisions governing the reimbursement methodology for inpatient hospital services rendered by children’s specialty hospitals to revise the reimbursement methodology and establish outlier payment provisions.  The proposed rule simply continues the provisions of the emergency rule.

 

For a full copy of the proposed rule, please click here.  A public hearing will be held on December 30, 2015 at 9:30 am.  The hearing will take place in Room 118, Bienville Building, 628 N. Foster St., Baton Rouge, LA. 

 

Please send any comments regarding this proposed rule change to Wes Hataway, Vice President of Legal Affairs, at wes@lsms.org.

 

Department of Health and Hospitals


DHH currently provides Medicaid reimbursement to non-state intermediate care facilities for persons with intellectual disabilities (ICFs/ID) for services provided Medicaid recipients.  The department promulgated an Emergency Rule which amended the provisions governing the reimbursement methodology for ICFs/ID to establish reimbursement for complex care services provided to Medicaid recipients residing in non-state ICFs/ID (Louisiana Register, Volume 40, Number 10).  This proposed rule is being promulgated to continue the provisions of the October 1, 2014, Emergency Rule. 

 

For a full copy of the proposed rule, please click here.  A public hearing will be held on December 30, 2015 at 9:30 am.  The hearing will take place in Room 118, Bienville Building, 628 N. Foster St., Baton Rouge, LA. 

 

Please send any comments regarding this proposed rule change to Wes Hataway, Vice President of Legal Affairs, at wes@lsms.org.

 

Final Rule


Louisiana State Board of Medical Examiners


As was mentioned in the October Administrative Rules Update, the final rule issue by the LSBME pertaining to “Unprofessional Conduct” contained a publication error.  The final rule inadvertently re-inserted a provision establishing criteria which must be met in order for a physician to be considered a “specialist”.  In light of the error, the final rule has been republished in the November Register.  The “specialist” provision has been deleted leaving only a provision defining “self-treatment; treatment of immediate family” as “unprofessional conduct”.

 

The full text of the final rule can be found here.

 

Department of Health and Hospitals


The Louisiana Health Insurance Premium Payment Program in the Medical Assistance Program has been repealed in accordance with Title XIX of the Social Security Act. 

 

Emergency Rules


The November edition contains several emergency rules which are simply continuations of previously enacted emergency rules.  They are as follows:

 

Department of Health and Hospitals


The Department of Health and Hospitals, Bureau of Health Services Financing and the Office of Aging and Adult Services amended the provisions governing the Community Choices Waiver to add two new waiver services, to incorporate a new service delivery method and to clarify the provisions governing personal assistance services (Louisiana Register, Volume 40, Number 4). The department promulgated an Emergency Rule which amended the provisions governing the Community Choices Waiver in order to clarify the provisions of the April 20, 2014 Rule (Louisiana Register, Volume 40, Number 11).  This Emergency Rule is being promulgated to continue the provisions of the November 20, 2014 Emergency Rule.  A full text of the emergency rule can be found here.

 

The department promulgated and Emergency Rule which amended the provisions governing the reimbursement methodology for ICFs/ID in order to adopt provisions to establish supplemental Medicaid payments for services provided to Medicaid recipients residing in privately-owned facilities that enter into a cooperative endeavor agreement with the department (Louisiana Register, Volume 41,

Number 8). This action is being taken to secure new federal funding, and to promote the health and welfare of Medicaid recipients by ensuring sufficient provider participation.  A full text of the emergency rule can be found here.

 

The department promulgated an Emergency Rule which amended the provisions governing reimbursement for Medicaid payments for outpatient services provided by nonstate owned major teaching hospitals participating in public private partnerships which assume the provision of services that were previously delivered and terminated or reduced by a state owned and operated facility (Louisiana Register, Volume 38, Number 4). This Emergency Rule is being promulgated to continue the provisions of the April 15, 2015 Emergency Rule.  A full text of the emergency rule can be found here.

 

The department promulgated an Emergency Rule which amended the provisions governing long-term personal care services (LT-PCS) in order to adopt requirements which mandate that LT-PCS providers must utilize the electronic visit verification (EVV) system designated by the department for automated scheduling, time and attendance tracking, and billing for long-term personal care services

(Louisiana Register, Volume 41, Number 3). This Emergency Rule is being promulgated to continue the provisions of the April 1, 2015 Emergency Rule.  A full text of the emergency rule can be found here.

 


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Louisiana State Medical Society

6767 Perkins Road, Suite 100
Baton Rouge, LA 70808

Ph: 800.375.9508 | 225.763.8500
Fax: 225.768.5601

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