Updates the State’s Asset Verification System (AVS) reflecting the State’s decision to go from using a contractor to build the system to joining a consortium to develop an Asset Verification System

Updates and extends the Ambulatory Patient Group (APG) methodology for hospital based clinics and ambulatory surgery services for the effective period January 1, 2020 thru December 31, 2020 and revise the APG methodology to reflect the recalculated weights with component updates

Quality improvement incentives

This amendment is to update the needs-based criteria; update who can perform evaluations and re-evaluations of 1915(i) eligibility; update language related to the CMS HCBS settings requirements; update who can perform the person-centered planning assessment; revise services covered under Habilitation services; and update reimbursement pages.

Updates the rates for Licensed Practical Nursing (LPN) private duty nursing services provided by a home health agency and adds more comprehensive language describing the reimbursement methodology for Extended Home Health Services.

Amendment extends services to pregnant women to implement tobacco cessation and as directed by CMS removes outdated references to the Louisiana Health Assessment Referral and Treatment (LaHART) program.

amends provisions governing the Pharmacy Benefits Management program in order to allow the state to pursue out-comes based agreements with manufacturers and to align the provisions with the current Medicaid State plan.

Autism spectrum-related service providers sections are being revised to increase access to service.

This plan amendment incorporates the 2020 Healthcare Common Procedure Coding System (HCPCS) changes (additions, deletions and description changes) to the Independent Therapy fee schedule. Codes that
are being added are being priced using a comparable methodology to other codes in the same or similar category. These changes are being made to ensure this fee schedule remains compliant with the Health
Insurance Portability and Accountability Act (HIPAA).

amends outpatient hospital reimbursement, which are required by the state’s settlement agreement with in-state nongovernmental licensed short-term general hospitals and implements state legislation in Public Act 19-1 of the December special session: (1) the ambulatory payment classification (APC) conversion factor increases to $77.12 effective January 1, 2020 and will increase by 2.2% per year effective for dates of service each subsequent January 1st through and including January 1, 2026; (2) the outpatient hospital flat fee schedule based on Revenue Center Codes (RCC