RÉSUMÉ DIGEST
ACT 582 (SB 564) 2018 Regular Session Luneau
Prior law provided for licensing of behavioral health services providers by the Louisiana
Department of Health (LDH) and requires that such providers be licensed in order to receive
Medicaid reimbursement. New law retains prior law and provides relative to specialized
behavioral health services providers that furnish community psychiatric support and
treatment (CPST) services or psychosocial rehabilitation (PSR) services.
New law defines "preliminary accreditation" as accreditation granted by an accrediting body
to an unaccredited program seeking full accreditation status.
New law requires the following for all behavioral health service providers providing PSR
or CPST services to Medicaid recipients to be eligible to receive reimbursement:
(1)Be licensed as a behavioral health service provider agency.
(2)Be accredited by a department-approved accrediting organization and meet the
following conditions:
(a)Show proof of full accreditation or obtain preliminary accreditation prior to
being contracted with a Medicaid managed care organization.
(b)Maintain proof of full accreditation or proof of preliminary accreditation.
(c)If not fully accredited on or before July 1, 2018, the provider shall attain full
accreditation within 18 months of its initial accreditation application date and
provide proof of full accreditation to each managed care organization with
which it is contracted.
(d)Maintain continuous full or preliminary accreditation.
(e)Cost of attaining and maintaining accreditation is the provider's
responsibility.
(f)Shall report any loss of accreditation, suspension of accreditation, reduction
to a preliminary accreditation status, or any other action that could result in
the loss of accreditation, to each managed care organization with which it is
contracted, within 24 hours of receipt of notification from the accreditation
body.
(3)Effective January 1, 2019, the provider is to have a National Provider Identification
number (NAI). Requires each provider agency to include its NAI number and the
NAI number of individuals rendering the PSR or CPST services on its behalf on all
claims for Medicaid reimbursement for dates of service on or after January 1, 2019.
(4)Implement a member choice form to be signed by each recipient, or the legal
guardian or representative of the recipient, receiving PSR or CPST in order to
prevent or reduce duplication of services.
(5)Be credentialed and in the provider network of the managed care organization that
the provider intends to submit claims for Medicaid services, unless the managed care
organization has a single case agreement with a provider agency not in its network.
(6)Meet any other requirements promulgated LDH to ensure the quality and
effectiveness of services.
New law requires all behavioral health service providers to ensure that any individual
rendering PSR or CPST services for the licensed and accredited provider agency meets all
of the following requirements in order to be eligible for reimbursement:
(1)For services rendered on or after January 1, 2019, the person rendering the PSR or
CPST services shall have an individual NAI number and that NAI number shall be
included on any claim by that provider agency for reimbursement related to such
services. (2)(a)On and after July 1, 2018, any individual rendering PSR services shall hold
a minimum of a bachelor's degree from an accredited university or college
in the field of counseling, social work, psychology, or sociology. If the
individual does not possess the minimum bachelor's degree but meets all
provider qualifications in effect prior to July 1, 2018, they may continue to
provide PSR services for the same provider agency. Requires the individual
rendering PSR services at a different provider agency to comply with
provisions in new law.
(b)On and after July 1, 2018, any individual rendering any CPST services shall
hold a minimum of a bachelor's degree from an accredited university or
college in the field of counseling, social work, psychology, or sociology.
(3)(a)Requires an individual rendering PSR or CPST services for a licensed and
accredited provider agency to meet all other requirements set forth in
Medicaid rules, regulations, provider manuals, and policies.
(b)Within 30 days of the effective date of new law, requires LDH to shall
commence any actions that are required to amend any existing department
rule or regulation that is in conflict with the requirements new law.
New law requires LDH to maintain a facility need review process for behavioral health
services providers that provide PSR or CPST services.
New law requires behavioral health services providers that provide PSR or CPST services
to employ a full-time mental health supervisor. Requires the mental health supervisor to
assist in the design and evaluation of PSR or CPST services.
New law requires LDH to implement a centralized credentialing verification organization
certified by the National Committee for Quality Assurance.
New law authorizes recoupment of Medicaid funds paid to a provider who is not in
compliance with new law. Provides for referral of such providers to the Medicaid Fraud
Control Unit of the attorney general's office for further action.
New law provides for rulemaking and audits of LDH by the legislative auditor with respect
to new law.
New law prohibits LDH from taking any final action resulting in the elimination of PSR and
CPST services unless the action is affirmatively approved by the legislative committees on
health and welfare.
Effective upon signature of governor (May 31, 2018).
(Adds R.S. 40:2162)