SB 190 requires Louisiana nursing homes identified by federal authorities as candidates for the Centers for Medicare and Medicaid Services' "Special Focus Facility Program" (due to persistent safety issues like abuse or health risks) to undergo enhanced state oversight. It mandates facilities to notify residents about safety concerns, offer transfer options, and comply with stricter state requirements - including quarterly unannounced inspections, root cause analyses, and staffing adjustments. If a facility fails to meet these requirements within 18 months, the state can revoke its license. The bill also prohibits repeat participation in the program, requiring license revocation or facility closure for repeat offenders.
HB 918 requires Louisiana's Department of Health to create a list of "critical prescription drugs" based on factors like cost to Medicaid, usage, and availability of alternatives. Drug manufacturers must report detailed cost data (including production, R&D, marketing, and international pricing) for drugs on this list. The bill also mandates that marketing materials to healthcare providers include current wholesale prices for each drug. These transparency measures aim to inform pricing decisions without directly setting drug costs.
HB 760 prohibits Louisiana Medicaid-enrolled healthcare providers from charging patients extra fees or co-payments for covered services related to medication-assisted treatment for substance use disorders. The bill requires providers to accept the Medicaid program’s payment as full payment for these services, eliminating unauthorized charges. Violations could lead to the provider’s termination or exclusion from Medicaid for up to one year. This directly affects Medicaid providers and patients receiving medication-assisted treatment, ensuring no out-of-pocket costs for these specific covered services.
HB 786 prohibits Louisiana's Medicaid managed care organizations from using "extrapolation" (mathematical estimation of unreviewed claims) when auditing healthcare providers. It requires that any payment adjustments for overpayments or underpayments be based solely on actual reviewed claims, not estimated totals. The bill directly affects healthcare providers receiving Medicaid payments and the private managed care organizations that administer those payments. Violations by managed care organizations can trigger penalties without prior notice, and contractual clauses attempting to waive these rules are void. This policy change ensures audits are based on verified data rather than estimates.
HB 689 requires Louisiana's Department of Children and Family Services (DCFS) to report within 72 hours when a child enters or leaves foster care custody to the Louisiana Department of Health. This ensures the health department can immediately adjust public assistance benefits for parents if a child is no longer living in their household - such as SNAP (food stamps), WIC, or FITAP benefits - and update Medicaid coverage for the child. The bill directly affects parents receiving benefits and children in foster care by streamlining benefit adjustments based on custody changes. It also mandates fraud investigations if individuals fail to report such changes, ensuring benefits align with current household circumstances.
SB 221 establishes that "treatment-in-place" services - where ambulance providers assess and treat patients at the scene of a 911 call without transporting them - must be covered under Louisiana's Medicaid program (medical assistance program). Ambulance providers (excluding air ambulance services) will be reimbursed at existing Medicaid fee schedule rates for these services, without requiring real-time video or audio communication with a doctor for reimbursement. The bill mandates that such services follow medical protocols and the provider's scope of practice, while the Louisiana Department of Health will create implementing rules. This directly affects Medicaid beneficiaries receiving non-transport emergency care and ambulance providers who serve them.
HCR 3 establishes a quarterly assessment on Louisiana hospitals to stabilize funding without using state general funds. It requires hospitals to pay a percentage of their inpatient and outpatient revenue (ranging from 1.38% to 6.74%, with exemptions for rural hospitals and small facilities under 40 beds). The collected funds support Medicaid reimbursement enhancements for hospitals, ensuring payments meet or exceed 2026 rates while aligning with federal CMS guidelines. This directly affects most acute care hospitals in Louisiana, excluding rural and small facilities, and aims to preserve hospital services for all residents.
SB 222 streamlines Medicaid behavioral health services in Louisiana by removing unnecessary administrative barriers for providers. It prohibits requiring pre-employment reference letters (§302), eliminates most CPR/first aid certification demands for staff (§303), aligns documentation timelines with federal standards (§305), and allows physician assistants with specific experience to serve as medical directors (§307). The bill also requires the state to seek federal approval for telehealth reimbursement of psychosocial services by July 2026 (§308). These changes directly affect Medicaid behavioral health providers, aiming to reduce duplication and expand workforce flexibility while maintaining care quality.
SB 369 requires Louisiana's state insurance plans (like Medicaid or Group Benefits) to pay pharmaceutical manufacturers no more than Medicare's price for covered drugs. It also prohibits insurers and pharmacy benefit managers from reimbursing less than Medicare's price for any brand-name, biosimilar, or generic drug. This sets Medicare's price as both a maximum for state plan purchases and a minimum for reimbursement, directly affecting drug manufacturers, insurers, and pharmacies serving Louisiana's state health programs. The bill takes effect January 1, 2027, and authorizes the state insurance commissioner to enforce these rules.
HB 198 requires Louisiana's Medicaid program to reimburse ambulatory surgical centers at least 100% of the Medicare rate for gastroenterology procedures. This directly affects outpatient surgical centers providing these specific medical services and ensures they receive consistent, updated payments. The bill mandates annual reimbursement adjustments to match Medicare rate changes and requires the Louisiana Department of Health to implement these changes by October 1, 2026. It also authorizes the Department to create necessary rules under state administrative procedures. This policy change standardizes payments for a defined set of procedures, aiming to maintain provider access to Medicaid coverage.
