SSHB435 4300 4012
HOUSE SUMMARY OF SENATE AMENDMENTS
HB 435 2023 Regular Session Freeman
MEDICAID: Provides relative to medicaid coverage of chimeric antigen receptor T-cell
therapy
Synopsis of Senate Amendments
1.Adds the promulgation of rules as necessary to regulate and provide payment
to healthcare providers for high-cost pharmaceutical carve-outs to the list of
duties charged to the secretary of LDH as required in proposed law.
Digest of Bill as Finally Passed by Senate
Proposed law defines "chimeric antigen receptor (CAR) T-cell therapy" and provides the
definition of "healthcare facility" as provided in present law.
Proposed law requires the Louisiana Medicaid program to provide inpatient and, if
appropriate, outpatient coverage for CAR T-cell therapy when such therapy has been
approved by the U.S. Food and Drug Administration, is used for a medically accepted
indication, and is administered in a healthcare facility appropriately providing CAR T-cell
therapy in accordance with state and federal guidelines or certifications.
Proposed law requires a healthcare facility appropriately providing CAR T-cell therapy in
accordance with state and federal guidelines or certifications to participate in the Louisiana
Medicaid program to provide CAR T-cell therapy to eligible enrollees, as defined in
proposed law.
Proposed law requires a healthcare facility appropriately providing CAR T-cell therapy in
accordance with state and federal guidelines or certifications to make a determination of a
prospective enrollee's eligibility for CAR T-cell therapy enrollment.
Proposed law establishes the following requirements for a prospective enrollee to be
considered eligible for CAR T-cell therapy enrollment:
(1) The individual is enrolled in the Louisiana Medicaid program.
(2)A licensed healthcare provider has certified that CAR T-cell therapy is medically
necessary and appropriate to treat the individual's condition.
(3)The CAR T-cell therapy is administered in a healthcare facility appropriately
providing CAR T-cell therapy in accordance with state and federal guidelines or
certifications.
Proposed law requires the secretary of the La. Dept. of Health to do the following:
(1) Submit to the Centers for Medicare and Medicaid Services all necessary state plan
amendments.
(2) Promulgate all necessary rules and regulations in accordance with present law.
(3)Promulgate rules as necessary to regulate and provide payment to healthcare
providers for high cost pharmaceutical carve-outs in accordance with the provisions
of proposed law.
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(4)Take any other actions necessary to implement the provisions of proposed law.
(Adds R.S. 40:1258.1 and 1258.2)
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