Louisiana Medicaid must cover CAR T-cell therapy when stated conditions are met, and participating facilities must provide it to eligible enrollees.
§1258.2. Medicaid coverage; enrollment qualifications; duties A. The Louisiana Medicaid program shall cover inpatient and, if deemed appropriate, outpatient coverage of CAR T-cell therapy when such therapy is approved by the United States Food and Drug Administration, used for a medically accepted indication, and administered in any healthcare facility appropriately providing CAR T-cell therapy in accordance with state and federal guidelines or certifications. B. Any healthcare facility appropriately providing CAR T-cell therapy in accordance with state and federal guidelines or certifications that participates in the Louisiana Medicaid program shall provide CAR T-cell therapy to an individual who is eligible for such enrollment as defined in Subsection C of this Section. C.(1) In order to receive coverage from the Louisiana Medicaid program for CAR T-cell therapy, the eligibility of a prospective enrollee shall be determined by the healthcare facility appropriately providing CAR T-cell therapy in accordance with state and federal guidelines or certifications as provided in Subsection B of this Section. (2) A prospective enrollee shall be considered eligible for CAR T-cell therapy enrollment if the individual satisfies all of the following qualifications: (a) The individual is enrolled in the Louisiana Medicaid program. (b) A licensed healthcare provider has certified that CAR T-cell therapy is medically necessary and appropriate to treat the individual's condition. (c) The CAR T-cell therapy is administered in any healthcare facility appropriately providing CAR T-cell therapy in accordance with state and federal guidelines or certifications. D. Pursuant to this Section, the secretary of the Louisiana Department of Health shall do all of 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 the Administrative Procedure Act. (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 this Part. (4) Take any other actions necessary to implement the provisions of this Section. Acts 2023, No. 294, §1.