Part XVII. Prosthetics and Orthotics

A. - B. …

C. Effective for dates of service on or after March 7, 2009, the reimbursement for prosthetic and orthotic devices shall be reduced by 3.5 percent of the fee amounts on file as of March 6, 2009.

1. The rate reduction shall not apply to items that do not appear on the fee schedule and are individually priced.

AUTHORITY NOTE: Promulgated in accordance with R. S. 36:254 and Title XIX of the Social Security Act.

HISTORICAL NOTE: Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 31:1597 (July 2005), amended LR 34:881 (May 2008), amended by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 35:

In compliance with Act 1183 of the 1999 Regular Session of the Louisiana Legislature, the impact of this proposed Rule on the family has been considered. It is anticipated that this proposed Rule may have an adverse impact on family functioning, stability and autonomy as described in R.S. 49:972 in the event that provider participation in the Medicaid Program is diminished as a result of reduced reimbursement rates.

Implementation of the provisions of this Rule is contingent upon the approval of the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services.

Interested persons may submit written comments to Jerry Phillips, Bureau of Health Services Financing, P.O. Box 91030, Baton Rouge, LA 70821-9030. He is responsible for responding to inquiries regarding this proposed Rule. A public hearing on this proposed Rule is scheduled for Wednesday, May 27, 2009 at 9:30 a.m. in Room 118, Bienville Building, 628 North Fourth Street, Baton Rouge, LA. At that time all interested persons will be afforded an opportunity to submit data, views or arguments either orally or in writing. The deadline for the receipt of all written comments is 4:30 p.m. on the next business day following the public hearing.

Secretary

It is anticipated that the implementation of this proposed rule will result in an estimated savings to the state of $9,986 for FY 08-09, $44,804 for FY 09-10, and $46,148 for FY 10-11. It is anticipated that $328 ($164 SGF and $164 FED) will be expended in FY 08-09 for the state’s administrative expense for promulgation of this proposed rule and the final rule. The numbers reflected above are based on the “hold harmless” Federal Medical Assistance Percentage (FMAP) as allowed in the American Recovery and Reinvestment Act of 2009 (72.47%). Additional federal funds are projected to be available in the current year through December 2010. To the extent that DHH utilizes federal match, up to the allowable match (estimated to be 80.01% in the current year) for the eligibility period (through December 2010), state general fund match could be reduced. In FY 10-11, the FMAP is projected to drop below the hold harmless rate by an unknown amount. In the event of this decrease, the state general funds will increase to the federally required match.

II. ESTIMATED EFFECT ON REVENUE COLLECTIONS OF STATE OR LOCAL GOVERNMENTAL UNITS (Summary)

It is anticipated that the implementation of this proposed rule will reduce federal revenue collections by approximately $26,554 for FY 08-09, $117,942 for FY 09-10, and $121,480 for FY 10-11. It is anticipated that $164 will be collected in FY 08-09 for the federal administrative expenses for promulgation of this proposed rule and the final rule. The numbers reflected above are based on the “hold harmless” Federal Medical Assistance Percentage (FMAP) as allowed in the American Recovery and Reinvestment Act of 2009 (72.47%). Additional federal funds are projected to be available in the current year through December 2010. To the extent that DHH utilizes federal match, up to the allowable match (estimated to be 80.01% in the current year) for the eligibility period (through December 2010), state general fund match could be reduced. In FY 10-11, the FMAP is projected to drop below the hold harmless rate by an unknown amount. In the event of this decrease, the state general funds will increase to the federally required match.

III. ESTIMATED COSTS AND/OR ECONOMIC BENEFITS TO DIRECTLY AFFECTED PERSONS OR NONGOVERNMENTAL GROUPS (Summary)

This rule, which continues the provisions of the March 7, 2009 emergency rule, proposes to amend the provisions governing the reimbursement methodology for prosthetic and orthotic devices to reduce the reimbursement rate. It is anticipated that implementation of this proposed rule will decrease program expenditures in the Medicaid Program by approximately $36,868 for FY 08-09, $162,746 for FY 09-10 and $167,628 for FY 10-11.

IV. ESTIMATED EFFECT ON COMPETITION AND EMPLOYMENT (Summary)

It is anticipated that the implementation of this proposed rule may have a negative effect on competition and employment as it will reduce the payment made to providers of prosthetic and orthotic devices. The reduction in payments may adversely impact the financial standing of providers and could possibly cause a reduction in employment opportunities.

Targeted Case Management―Reimbursement Rate Reduction (LAC 50:XV.10701)

The Department of Health and Hospitals, Bureau of Health Services Financing proposes to amend LAC 50: XV.10701 in the Medical Assistance Program as authorized by R.S. 36:254 and pursuant to Title XIX of the Social Security Act and as directed by Act 19 of the 2008 Regular Session of the Louisiana Legislature which states: "The secretary shall, subject to the review and approval of the Joint Legislative Committee on the Budget, implement reductions in the Medicaid program as necessary to control expenditures to the level appropriated in this schedule. Notwithstanding any law to the contrary, the secretary is hereby directed to utilize various cost-containment measures to accomplish these reductions, including but not limited to precertification, preadmission screening, diversion, fraud control, utilization review and management, prior authorization, service limitations and other measures as allowed by federal law.” This proposed Rule is promulgated in accordance with the Administrative Procedure Act, R. S. 49:950, et seq.

The Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing amended the provisions governing the reimbursement methodology for targeted case management services to: 1) require case management agencies to bill in 15 minute increments; 2) establish cost reporting requirements; and 3) increase the reimbursement rate paid for targeted case management services provided to infants and toddlers (Louisiana Register, Volume 35, Number 1).

As a result of a budgetary shortfall, the bureau promulgated an Emergency Rule to amend the provisions governing the reimbursement methodology for targeted case management to reduce the reimbursement rate (Louisiana Register, Volume 35, Number 2). This rate reduction was not applicable to Infants and Toddlers and EPSDT case management. This proposed Rule is being promulgated to continue the provisions of the February 1, 2009 Emergency Rule.

Title 50

PUBLIC HEALTH—MEDICAL ASSISTANCE

Part XV. Services for Special Populations

Subpart 7. Targeted Case Management

Chapter 107. Reimbursement

§10701. Reimbursement

A. - D. …

E. Effective for dates of service on or after February 1, 2009, the reimbursement for case management services provided to the following targeted populations shall be reduced by 3.5 percent of the rates on file as of January 31, 2009:

1. participants in the Nurse Family Partnership Program;

2. individuals with developmental disabilities who are participants in the New Opportunities Waiver; and

3. individuals with disabilities resulting from HIV.

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.

HISTORICAL NOTE: Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 30:1040 (May 2004), amended LR 31:2032 (August 2005), amended LR 35:73 (January 2009), amended LR 35:

In compliance with Act 1183 of the 1999 Regular Session of the Louisiana Legislature, the impact of this proposed Rule on the family has been considered. It is anticipated that this proposed Rule may have an adverse impact on family functioning, stability and autonomy as described in R.S. 49:972 in the event that provider participation in the Medicaid Program is diminished as a result of reduced reimbursement rates.

Implementation of the provisions of this Rule is contingent upon the approval of the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services.

Interested persons may submit written comments to Jerry Phillips, Bureau of Health Services Financing, P.O. Box 91030, Baton Rouge, LA 70821-9030. He is responsible for responding to inquiries regarding this proposed Rule. A public hearing on this proposed Rule is scheduled for Wednesday, May 27, 2009 at 9:30 a.m. in Room 118, Bienville Building, 628 North Fourth Street, Baton Rouge, LA. At that time all interested persons will be afforded an opportunity to submit data, views or arguments either orally or in writing. The deadline for the receipt of all written comments is 4:30 p.m. on the next business day following the public hearing.

Secretary

I. ESTIMATED IMPLEMENTATION COSTS (SAVINGS) TO STATE OR LOCAL GOVERNMENT UNITS (Summary)

It is anticipated that the implementation of this proposed rule will result in an estimated savings to the state of $45,589 for FY 08-09, $171,365 for FY 09-10, and $176,506 for FY 10-11. It is anticipated that $328 ($164 SGF and $164 FED) will be expended in FY 08-09 for the state’s administrative expense for promulgation of this proposed rule and the final rule. The numbers reflected above are based on the “hold harmless” Federal Medical Assistance Percentage (FMAP) as allowed in the American Recovery and Reinvestment Act of 2009 (72.47%). Additional federal funds are projected to be available in the current year through December 2010. To the extent that DHH utilizes federal match, up to the allowable match (estimated to be 80.01% in the current year) for the eligibility period (through December 2010), state general fund match could be reduced. In FY 10-11, the FMAP is projected to drop below the hold harmless rate by an unknown amount. In the event of this decrease, the state general funds will increase to the federally required match.

II. ESTIMATED EFFECT ON REVENUE COLLECTIONS OF STATE OR LOCAL GOVERNMENTAL UNITS (Summary)

It is anticipated that the implementation of this proposed rule will reduce federal revenue collections by approximately $120,276 for FY 08-09, $451,103 for FY 09-10, and $464,636 for FY 10-11. It is anticipated that $164 will be collected in FY 08-09 for the federal administrative expenses for promulgation of this proposed rule and the final rule. The numbers reflected above are based on the “hold harmless” Federal Medical Assistance Percentage (FMAP) as allowed in the American Recovery and Reinvestment Act of 2009 (72.47%). Additional federal funds are projected to be available in the current year through December 2010. To the extent that DHH utilizes federal match, up to the allowable match (estimated to be 80.01% in the current year) for the eligibility period (through December 2010), state general fund match could be reduced. In FY 10-11, the FMAP is projected to drop below the hold harmless rate by an unknown amount. In the event of this decrease, the state general funds will increase to the federally required match.

III. ESTIMATED COSTS AND/OR ECONOMIC BENEFITS TO DIRECTLY AFFECTED PERSONS OR NONGOVERNMENTAL GROUPS (Summary)

This rule, which continues the provisions of the February 1, 2009 emergency rule, proposes to reduce the reimbursement rates paid for targeted case management (TCM) services (approximately 7,174 cases). It is anticipated that implementation of this proposed rule will decrease program

expenditures in the Medicaid Program by approximately $166,193 for FY 08-09, $622,468 for FY 09-10 and $641,142 for FY 10-11.

IV. ESTIMATED EFFECT ON COMPETITION AND EMPLOYMENT (Summary)

It is anticipated that the implementation of this proposed rule may have a negative effect on competition and employment as it will reduce the payment made to providers of targeted case management services. The reduction in payments may adversely impact the financial standing of TCM providers and could possibly cause a reduction in employment opportunities.

Management of Refuse, Infectious Waste, Medical Waste, and Potentially Infectious Biomedical Waste

Notice is hereby given, in accordance with the Administrative Procedure Act, R.S. 49:950 et seq., that the state health officer acting through the Department of Health and Hospitals, Office of Public Health, pursuant to the authority in R.S. 40:4(A)(2)(b)(ii) and R.S. 40:5, intends to amend and revise Title 51, Part XXVII (Management of Refuse, Infectious Waste, Medical Waste, and Potentially Infectious Biomedical Waste) by effecting substantive changes as outlined below.

A. Unless otherwise specifically provided herein, the following words and terms used in this Part of the sanitary code are defined for the purposes thereof as follows.

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Transporterany person or firm who transports large quantities of potentially infectious biomedical waste or who transports any quantity of such waste generated by another. This definition shall not apply to municipal waste haulers who transport such waste disposed of in household waste under the provisions of §503.A.

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HISTORICAL NOTE: Promulgated by the Department of Health and Hospitals, Office of Public Health, LR 28:1450 (June 2002), amended LR 35:

A. - C. …

AUTHORITY NOTE: Promulgated in accordance with R.S. 40:4(A)(2)(b) and R.S. 40:5.

HISTORICAL NOTE: Promulgated by the Department of Health and Hospitals, Office of Public Health, LR 28:1452 (June 2002), amended LR 35:

A. [Formerly §501.D] Small quantities of potentially infectious biomedical waste generated as a result of self administered or non professional health care or veterinary care services in a household or other non health care facility may be disposed of in ordinary municipal waste without treatment, provided that such waste is packaged to assure no loss of contents, should the integrity of the original package be violated. This shall generally be interpreted to mean placing the original plastic bag or rigid disposal into a second bag or rigid disposal container. Sharps must be encased as specified in §1101 or placed in a sharps disposal container of standard manufacture or other similar container of a type approved by the state health officer. This sharps container should then be placed within another bag or rigid container containing a greater volume of non infectious waste.

B. On an annual basis, all persons who collect and transport public municipal household waste shall provide a copy of the Department of Health and Hospitals—Office of Public Health’s (DHH-OPH) educational brochure to its clients to include the current DHH-OPH procedures for the proper handling, packaging, treatment and disposal of home generated sharps and medical wastes. Persons who collect municipal household waste shall direct clients to their own name and contact numbers on the brochure for client questions.

C. No later than January 31 of each year, persons who collect and transport municipal household wastes shall provide written certification to DHH-OPH that it has complied with Subsection B of this Section for the previous calendar year. A copy of the brochure and any additional information provided to each household in this effort shall accompany the certification.

AUTHORITY NOTE: Promulgated in accordance with R.S. 40:4(A)(2)(b) and R.S. 40:5.

HISTORICAL NOTE: Promulgated by the Department of Health and Hospitals, Office of Public Health, LR 35:

DHH-OPH will conduct a public hearing at 10 a.m. on Wednesday, May 27, 2009 in Room 132 of the Bienville Building, 628 North Fourth Street, Baton Rouge, LA. Persons attending the hearing may have their parking ticket validated when one parks in the 7-story Galvez Parking Garage which is located between N. Sixth and N. Fifth/North and Main Sts. (catercorner and across the street from the Bienville Building). All interested persons are invited to attend and present data, views, comments, or arguments, orally or in writing.

In addition, all interested persons are invited to submit written comments on the proposed Rule. Such comments must be received no later than Friday, May 29, 2009 at COB, 4:30 p.m., and should be addressed to Mr. Albert Mancuso, Infectious Wastes Program Administrator, Sanitarian Services Section, Center for Environmental Health Services, Office of Public Health, CEHS Mail Bin #10, P.O. Box 4489, Baton Rouge, LA 70821-4489, or faxed to (225) 342-7552. If comments are to be shipped or hand-delivered, please deliver to the Bienville Building, 628 N. Fourth Street, Room 150, Baton Rouge, LA 70802.
Alan Levine

Secretary

The purpose of this rule is to amend Title 51, Part XXVII, Management of Refuse, Infectious Waste, and Medical Waste, and Potentially Infectious Biomedical Waste per Act 267 of the 2007 Regular Legislative Session. This rule adds language to require that waste collectors annually provide a copy of the Department of Health and Hospital-Office of Public Health educational brochure to its clients. The purpose of the brochure is to provide information regarding the proper handling, packaging, treatment and disposal of home generated sharps and medical wastes.

For FY 2008-09, the proposed rule change will result in an estimated cost to DHH/OPH of $3,064 for printing 30,000 copies of the educational brochure to distribute to health clinics and to use for public relations campaigns. It will cost an additional $430 to publish the notice of intent and the final rule in the Louisiana Register. The total cost for FY 2008-09 is $3,494. This cost will be funded with State General Fund revenues appropriated in the agency’s current year budget.

For subsequent fiscal years, DHH/OPH estimates a cost of $3,156 for FY 09-10 and $3,251 for FY 10-11 to print 30,000 copies for each year. This cost includes a 3% inflation adjustment. DHH/OPH anticipates that this cost will be funded with State General Fund.

II. ESTIMATED EFFECT ON REVENUE COLLECTIONS OF STATE OR LOCAL GOVERNMENTAL UNITS (Summary)

There are no effects on revenue collections of state or local governmental units anticipated as a result of promulgation of this regulation.

III. ESTIMATED COSTS AND/OR ECONOMIC BENEFITS TO DIRECTLY AFFECTED PERSONS OR NONGOVERNMENTAL GROUPS (Summary)

All persons who collect and transport municipal household waste will be required to print and distribute the DHH/OPH educational brochure at their expense. The total cost these persons will incur depends on the number of clients served; however, it is reasonably estimated that the printing cost should be similar to DHH/OPH per copy cost of 10 cents.

IV. ESTIMATED EFFECT ON COMPETITION AND EMPLOYMENT (Summary)

There is no effect on competition and employment anticipated as a result of promulgation of this regulation.

Marine and Freshwater Animal Food Products

Editor's Note: This Notice of Intent is being reprinted because of an error upon submission. The original Rule can be viewed in its entirety on page 545 of the March 20, 2009 Louisiana Register.

Notice is hereby given, in accordance with the Administrative Procedure Act, R.S. 49:950 et seq., that the state health officer acting through the Department of Health and Hospitals, Office of Public Health, pursuant to the authority in R.S. 40:4(A)(6) and R.S. 40:5, intends to amend and revise Title 51, Part IX (Marine and Fresh Water Animal Food Products), by effecting changes as outlined below. The proposed change will result in code provisions which are consistent with the National Shellfish Sanitation Program (NSSP) 2007 Model Ordinance. The NSSP is the federal/state cooperative program recognized by the U.S. Food and Drug Administration (FDA) and the Interstate Shellfish Sanitation Conference (ISSC) for the sanitary control of shellfish produced and sold for human consumption.

Title 51

PUBLIC HEALTH—SANITARY CODE