Louisiana Administrative Code

A. These procedures apply to all water quality certifications which applicants for federal licenses or permits are required to provide to the appropriate federal agency. B. In the event that certification is requested for a proposed federal license or permit which is determined b…

Administrative Authority—the Secretary of the Department of Environmental Quality or his designee or the appropriate assistant secretary or his designee. Certification—approval by the administrative authority that any activity which may result in any discharge into or potential c…

A. Application Requirements 1. Application Requirements. Any person, desiring issuance of a state water quality certification, shall file an application for certification with the Department of Environmental Quality at its office in Baton Rouge. The application should include: a.…

A. The Medicaid Program hereby adopts provisions to provide coverage for medication-assisted treatment provided in Opioid Treatment Programs, including but not limited to, methadone treatment, to all Medicaid-eligible adults and children with opioid use disorder (OUD).

A. Adults and children who meet Medicaid eligibility and clinical criteria shall qualify to receive medically necessary OUD services in Opioid Treatment Programs. B. Qualifying recipients must meet the following criteria: 1. are at least 18 years old, unless the recipient has con…

A. This regulation is promulgated by the commissioner of insurance pursuant to authority granted under subpart C of chapter 1 of title 22 of the Revised Statutes (R.S. 22:31 et seq., “equal opportunity in insurance”), which provides the following: 1. the Department of Insurance D…

A. The purpose of this regulation is to implement the provisions of R.S. 22:31 et seq., which prohibit discrimination within the business of insurance, mandate the review and disposition of all complaints alleging a violation of R.S. 22:31 et seq., and require the commissioner to…

A. For the purposes of this regulation, these terms shall have the meaning ascribed herein unless the context clearly indicates otherwise. Affirmative Action Plan—a document that contains a stated purpose of the insurer to foster equal opportunities for minorities and the delinea…

A. Any person may file a complaint regarding any action taken by an insurer that is alleged to be the result of an insurer’s engagement in discrimination as described in §15103.B of this Part. Complaints may be filed by mail, facsimile, or by using the department’s consumer compl…

A. After receipt of a complaint, the Division of Diversity and Opportunity shall notify the insurer against whom the complaint was filed. Notice to the insurer shall state the nature of the complaint and shall request that the insurer file a written response to the allegations of…

A. The Division of Diversity and Opportunity shall consider any affirmative action plan submitted to it, along with any other pertinent information submitted to it, in investigating complaints alleging employment discrimination prohibited by part IV of chapter 3-A of title 23 (R.…

A. In the event the Division of Diversity and Opportunity finds an apparent violation of R.S. 22:31 et seq., the commissioner may apply penalties as provided for in the Insurance Code. 1. for employment discrimination prohibited by part IV of chapter 3-A of title 23 (R.S. 23:331 …

A. Prior to the imposition of a penalty or sanction for an apparent violation of R.S. 22:31 et seq., an aggrieved party affected by a decision, act, or order of the commissioner may make a written demand for a hearing in accordance with R.S. 22:2191 et seq.

A. This regulation shall not preclude or in any way limit the applicability of R.S. 22:14(A), which prohibits any insurer transacting business in this state from penalizing any of its employees for reporting to the commissioner or other appropriate authorities, in good faith, a s…

A. If any Section or provision of Regulation 108 or its application to any persons or circumstances is held invalid, such invalidity or determination shall not affect other Sections or provisions or the application of Regulation 108 to any persons or circumstances that can be giv…

A. Effective for dates of service on or after May 15, 2017, the federal medical assistance percentage (FMAP) rate received by the department for specified adult vaccines and clinical preventive services shall increase one percentage point of the rate on file as of May 14, 2017. 1…

A. Effective for dates of service on or after February 20, 2011, the Medicaid Program shall provide reimbursement for diabetes self-management training services rendered by qualified health care professionals. B. Reimbursement for DSMT services shall be a flat fee based on the ap…

A. Effective for dates of service on or after December 1, 2011, the Medicaid Program shall provide reimbursement for fluoride varnish application services rendered by qualified health care professionals in a physician office setting. B. Reimbursement for fluoride varnish applicat…

A. Effective for dates of service on or after June 20, 2023, the Medicaid Program shall provide reimbursement for tobacco cessation counseling services rendered by qualified health care professionals. B. Reimbursement for tobacco cessation counseling services shall be a flat fee …

A. Effective for dates of service on or after July 1, 2012, the Medicaid Program will not provide reimbursement to providers in the Professional Services Program for “never events” or medical procedures performed in error which are preventable and have a serious, adverse impact t…

A. Induced deliveries and cesarean sections by physicians or nurse midwives shall not be reimbursed when performed prior to 39 weeks gestation. This shall not apply to deliveries when there is a documented medical condition that would justify delivery prior to 39 weeks gestation.

A. Qualifying Criteria. Effective for dates of service on or after February 1, 2018, in order to qualify to receive enhanced rate payments for services rendered to Medicaid recipients under these provisions, physicians and other eligible professional service practitioners must be…

A. Physicians shall be reimbursed according to the established fee schedule or billed charges, whichever is the lesser amount. B. Optometrists rendering eye care services shall be reimbursed using the same methodology as physicians rendering the same eye care services. C. Advance…

A. For newly added procedure codes for beneficiaries age 0 through 15 years old, the Medicaid fee shall be set at 90 percent of the current year’s Louisiana Region 99 Medicare allowable fee. For newly added procedure codes for beneficiaries age 16 years and older, the Medicaid fe…

A. Effective for dates of service on or after October 20, 2007, the Medicaid Program shall provide reimbursement for the payment of adjunct services in addition to the reimbursement for evaluation and management services and the associated ancillary services when these profession…

A. The most appropriate procedure codes and modifiers shall be used when billing for surgical anesthesia procedures and/or other services performed under the professional licensure of the physician (anesthesiologist or other specialty) or certified registered nurse anesthetist (C…

A. Reimbursement is based on formulas related to a percentage of the 2009 Louisiana Medicare Region 99 allowable. B. Effective for dates of service on or after January 22, 2010, the reimbursement for formula-based anesthesia services rendered by a physician shall be: 1. 75 percen…

A. Reimbursement for maternity related anesthesia services is a flat fee, except for general anesthesia related to a vaginal delivery which is reimbursed according to a formula. B. Other anesthesia services that are performed under the professional licensure of the physician (ane…

A. Reimbursement for family planning services shall be made according to the established fee schedule or billed charges, whichever is the lesser amount.

A. The reimbursement methodology for family planning services is the same as for physician services.

A. Qualifying Criteria. Effective for dates of service on or after February 21, 2017, in order to qualify to receive supplemental payments, physicians and other eligible professional service practitioners must be: 1. licensed by the state of Louisiana; 2. enrolled as a Louisiana …

A. Qualifying Criteria. Effective for dates of service on or after February 21, 2017, in order to qualify to receive supplemental payments, physicians and other eligible professional service practitioners must be: 1. licensed by the state of Louisiana; 2. enrolled as a Louisiana …

A. Effective for dates of service on or after July 1, 2012, physicians and other eligible professional service practitioners who are employed by a physician group affiliated with Tulane University School of Medicine located in the city of New Orleans may qualify for supplemental …

A. Certified nurse midwives and licensed midwives shall be reimbursed as a percentage of physician reimbursement according to the established fee schedule.

A. Effective for dates of service on or after August 1, 2023, services related to pregnancy and childbirth provided by certified nurse midwives (including licensed midwives), shall be reimbursed at 95 percent of the physician fee on file.

A. Reimbursement for doula services shall be made according to the established fee schedule or billed charges, whichever is the lesser amount.

A. Effective for dates of service on or after [day of promulgation], reimbursement for doula services shall be a flat fee per service based on the appropriate current procedural terminology (CPT) code.

A. Louisiana R.S. 40:1300.111 et seq. established a “state health care data clearinghouse” in the Office of Public Health with responsibility for the collection and dissemination of health care data. The legislative action was based upon a finding that as a consequence of rising …

A. For the purposes of these regulations, the following words and phrases, when used herein, shall be construed as listed below. Act—the Act 622 of the 1997 Regular Legislative Session, R.S. 40: 1300.111 et seq. Aggregate Data Set—an array of counts of patient level records, or o…

A. Act 622 of 1997 provides for the strictest confidentiality of data and severe penalties for violation of the Act. After editing and compilation of data submitted under this rule, the Office of Public Health shall separate all secure information from the rest of the file. Redun…

A. Patient level data (raw or cleaned) may be released by OPH to the data provider that submitted that particular data. B. The office may use patient level data in fulfilling its public health mission. The office will establish procedures for secure use of the data by OPH staff. …

A. Any person may apply to the office to conduct research for health surveillance, public education, administrative, or health industry purposes using patient level data. Non-aggregate data (patient level data) shall be disclosed only when the Hospital Discharge Data Research Pan…

b. The office shall act upon an Application for Waiver within 20 days of receiving the written request. Failure of the office to act on the application shall be deemed as a grant of the waiver. c. A denial of the Application for Waiver shall be appealable to the assistant secreta…

A. Data Reporting Source. All facilities operated and licensed as a hospital in the state of Louisiana by the Louisiana Department of Health and Hospitals will report discharge data to the Office of Public Health (OPH) for each patient admitted as an inpatient. A failure to repor…

A. Each licensed Louisiana hospital which collects Hospital Discharge Information, as set forth in this rule, shall submit Hospital Discharge Records to the Office of Public Health in a manner that complies with the provisions of the guidelines here included for all hospital disc…

A. Third-party intermediaries may be utilized by hospitals for the delivery of data to the Office of Public Health. Intermediaries must be registered with OPH on registration forms provided by the Office. Additions and deletions to the intermediary's list of hospitals represented…

A. All hospitals will submit discharge data in a form consistent with the requirements unless an extension or waiver has been granted. Extensions may be granted when the hospital documents that unforeseen difficulties, such as technical problems, prevent compliance. Waivers may b…

A. Hospitals will review the discharge data records prior to submittal for accuracy and completeness. Correction of invalid records and validation of aggregate tabulation are the responsibility of the hospital. All hospitals will certify the data submitted for each reporting peri…

A. Currently, data may be submitted by modem (the preferred method), PC diskette, CD-ROM, magnetic tape (reel), or electronic media to be determined by OPH. Additional media or modes of transfer will be announced by OPH as they become available. Data submittals not in compliance …

A. Listed below are required and conditionally required data elements. Submission of any other data elements is optional; hospitals do not need to suppress or strip other elements appearing in their claims files. All elements submitted will be treated confidentially. 1. Required …