§159.1. Hospice care pilot program; rules and regulations

A. The Louisiana Department of Health shall develop and implement a pilot project for hospice care under the Medicaid State Plan for persons who are eligible for Medicaid benefits under Title XIX of the Social Security Act. Such pilot project shall use Medicaid funds and to the extent possible reduce the Medicaid costs to the state. Implementation of the pilot project shall be subject to approval by the secretary of the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services, for federal reimbursement and shall be subject to limitations of state appropriations and federal matching funds.

B. For the purposes of this Section, the definition of "hospice care" shall be the definition in 42 U.S.C. 1396d(o).

C. Coverage of hospice care under the pilot project shall be in accordance with 42 U.S.C. 1396d(o), the Medicare Hospice Program guidelines as set forth in 42 CFR Part 418, and Sections 4305-4308.2 of the federal Centers for Medicare and Medicaid Services' State Medicaid Manual. In the case of an individual who is eligible for Medicaid benefits under Title XIX of the Social Security Act, occupies a Medicaid-certified nursing facility bed, and elects to receive hospice care, an additional amount for room and board shall be paid to the hospice that shall not be less than one hundred percent of the per diem rate that would have been paid to the nursing facility under the Medicaid State Plan.

D. In order to participate in the pilot project, a hospice shall meet the Medicare conditions of participation for hospice as set forth in 42 CFR Part 418 and shall have a valid Medicaid provider agreement.

E. The secretary of the Louisiana Department of Health shall promulgate the necessary rules and regulations to implement the provisions of this Section in accordance with the Administrative Procedure Act. Such rules and regulations shall include provisions for the certification of the reasonableness and medical necessity of the hospice care.

F. The Louisiana Department of Health is authorized to consult with other states that include hospice care under their Medicaid State Plan for assistance in implementing the provisions of this Section.

Acts 2001, No. 756, §1, eff. June 25, 2001; Acts 2018, No. 206, §5.