Louisiana Revised Statutes 46:460.54 – 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 th
Terms Used In Louisiana Revised Statutes 46:460.54
- Amendment: A proposal to alter the text of a pending bill or other measure by striking out some of it, by inserting new language, or both. Before an amendment becomes part of the measure, thelegislature must agree to it.
- Contract: A legal written agreement that becomes binding when signed.
- Department: means the Louisiana Department of Health. See Louisiana Revised Statutes 46:460.51
- Enrollee: means an individual who is enrolled in the Medicaid program. See Louisiana Revised Statutes 46:460.51
- Policy or procedure: shall mean a requirement governing the administration of managed care organizations specific to billing guidelines, medical management and utilization review guidelines, case management guidelines, claims processing guidelines and edits, grievance and appeals procedures and process, other guidelines or manuals containing pertinent information related to operations and pre-processing claims, and core benefits and services. See Louisiana Revised Statutes 46:460.51
- provider: means a person, partnership, limited liability partnership, limited liability company, corporation, facility, or institution that provides healthcare or professional services to individuals enrolled in the Medicaid program. See Louisiana Revised Statutes 46:460.51
- services: means the services, items, supplies, or drugs for the diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or disease. See Louisiana Revised Statutes 46:460.51
- Telehealth: has the meaning ascribed in La. See Louisiana Revised Statutes 46:460.51
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.