Louisiana medicaid manual. Pharmacies must return to Chapter Two of the Medicaid Services Manual . Providers must comply with the service coverage Manual Purpose and Organization. Louisiana Office of Aging and Adult Services (OAAS) . 3 ; Mailing: Louisiana Department of Health | P. It is maintained by the Louisiana Department of Health, Bureau Louisiana Affordable Care Act (ACA) Medicaid expansion. The manual is intended to make available to Medicaid providers of Portable X -ray services a ready LOUISIANA MEDICAID PROGRAM ISSUED: 09/24/21 REPLACED: 06/01/20 CHAPTER 5: PROFESSIONAL SERVICES SECTION 5. 6: LT-PCS - PROVIDER REQUIREMENTS PAGE(S) 7 Page 3 of 7 Section 30. Within Healthy Louisiana, there are four broad categories Services must be rendered per the requirements outlined by the Louisiana Department of Health (LDH) and Louisiana Medicaid as detailed in the Behavioral Health Services Provider Medicaid Customer Service: 1. When you receive a letter in the mail from Louisiana Medicaid, follow the instructions in the letter so you don’t risk losing your coverage. Page (s) Reason for Revision . 7 %µµµµ 1 0 obj >/Metadata 6939 0 R/ViewerPreferences 6940 0 R>> endobj 2 0 obj > endobj 3 0 obj > endobj 4 0 obj >/ExtGState >/XObject >/ProcSet[/PDF/Text Chapter Forty of the Medicaid Services Manual . An enrolled Medicaid provider is entitled to a provider manual for the specific program in which he or she Louisiana Medicaid is switching to Magellan Medicaid Administration to manage pharmacy benefits for all Medicaid health plans. Manual Chapter 39 - Title Page. manuals containing pertinent information related to operations and pre-processing claims, and core benefits and services. 4th Street | Baton Rouge, LA 70802 | PHONE: 225-342-9500 | FAX: 225-342-5568 Medicaid Customer Service 1-888-342-6207 | Healthy Louisiana 1-855-229-6848 This Manual is intended to accompany the Contract rather than be standalone and a exhaustive compilation of contractual requirements. Claims/authorizations for dates of service on or after October 1, 2015 Louisiana Medicaid reimburses ESRD for both routine and nonprovidersroutine laboratory - services. LOUISIANA MEDICAID PROGRAM ISSUED: 10/04/23 REPLACED: 08/25/21 LOUISIANA MEDICAID PROGRAM ISSUED: 10/04/23 REPLACED: 08/25/21 CHAPTER 24: HOSPICE Louisiana Medicaid Eligibility Manual Charts Issued November ??, 2023 Page 1 of Z-800 Replacing May 15, 2023 Revised/added text indicated by underscore Deleted text indicated by “**” SPOUSAL IMPOVERISHMENT . Behavioral Health Services Provider Manual. Select CTRL+F. This Manual also applies to major subcontractors with In this manual, you can easily find information about: • Covered services • Member eligibility • Prior authorizations • Claims and encounter submission • Provider responsibilities • Quality and compliance • Care management • Population health programs and incentives • Grievance and appeals Humana Healthy Horizons in Louisiana distributes its member rights and Welcome to Prime Therapeutics State Government Solutions Pharmacy Portal, administered by Prime Therapeutics, provides support for the Louisiana Medicaid managed care plans' (Aetna Better Health, AmeriHealth Caritas Louisiana, Healthy Blue Louisiana, Humana Healthy Horizons in Louisiana, Louisiana Healthcare Connections, and UnitedHealthcare Services must be rendered per the requirements outlined by the Louisiana Department of Health (LDH) and Louisiana Medicaid as detailed in the Behavioral Health Services Provider Manual and any Informational Bulletins active on the service date. 9500 | Fax determined eligible for Louisiana Medicaid or CHIP, behavioral health and substance use or who belong to mandatory or voluntary managed care populations. 7 %¡³Å× 1 0 obj > endobj 2 0 obj > endobj 3 0 obj > endobj 4 0 obj >/MediaBox[ 0 0 612 792]/Parent 2 0 R /Resources >/Font >/ProcSet[/PDF/Text/ImageB Mailing: Louisiana Department of Health | P. 9500 | Fax The Louisiana Department of Health protects and promotes health and ensures access to medical, preventive and rehabilitative services for all citizens of the State of Louisiana. Part 441 Subpart B -Early and Periodic Screening, Diagnosis, and Treatment (EPSDT), as well as be in Chapter Twenty-Five of the Medicaid Services Manual . REQUIRED Enter the recipient s 13 digit Medicaid ID number exactly as it appears in the recipient s current Medicaid information using the plastic Medicaid swipe card (MEVS), e-MEVS, or through REVS Louisiana Medicaid Eligibility Manual Eligibility Determinations Issued July 31, 2024 Page 2 of H-800 Replacing February 6, 2023 Revised/added text indicated by underscore Deleted text indicated by “**” A Medicare certified skilled nursing facility (SNF); or A Medicaid certified ICF/IID facility. CHOOSE YOUR LOUISIANA MEDICAID DENTAL PLAN. 9500 | Fax Providers should refer to the Medicaid Services Manual, Chapter 1 General Information and Administration, Section 1. 6 • Have a written policy and procedures manual describing the provisions governing Mailing: Louisiana Department of Health | P. Guideline: Outpatient Applied Behavior Analysis (ABA): Louisiana Healthcare Connections Effective Date: January 1, 2024 Last Revision Date: October 13, 2023 Guideline Magellan Healthcare, Inc. 229. Issued December 1, 2010 . In addition, some sections of the primary National Network Manual are repeated for convenience LOUISIANA HEALTHCARE CONNECTIONS Page 1 of 9 —PROPRIETARY . 11 2. Z-1300 . Section 2. Issued February 1, 2012 . Welcome. LOUISIANA MEDICAID PROGRAM ISSUED: 09/27/24 REPLACED: 11/27/23 CHAPTER 18: DURABLE MEDICAL EQUIPMENT SECTION: TABLE OF CONTENTS PAGE(S) 8 Page 1 of 8 Table of Contents DURABLE MEDICAL EQUIPMENT . The following documents, forms, links and manuals are available on the following website addresses: LOUISIANA MEDICAID PROGRAM ISSUED: 04/26/10 REPLACED: 10/01/09 CHAPTER 30: PERSONAL CARE SERVICES SECTION 30. Instead, benefits Medicaidare suspended during the incarceration segment and members are unlinked (i. LOUISIANA MEDICAID PROGRAM ISSUED: 10/26/21 REPLACED: 09/28/21 CHAPTER 25: HOSPITAL SERVICES SECTION: TABLE OF CONTENTS PAGE(S) 4 Page 1 of 4 Table of Contents HOSPITAL SERVICES . 1 Covered Services. Medicaid Services Manual located on the Louisiana Medicaid website for general (below) LOUISIANA MEDICAID PROGRAM ISSUED: 03/17/21 REPLACED: 03/02/20 CHAPTER 9: ADULT DAY HEALTH CARE WAIVER SECTION 9. Each program has a provider manual containing general Medicaid information, specific program information, and billing policies and procedures. 12 2. LDH has provided the links below to assist each Managed Care Organization in obtaining information regarding Medicaid Fee Schedules, Hospital Provider Per Diem Rates, Excluded Services Chart and most recently ICD-10 Implementation for Louisiana Medicaid Legacy Claims. This manual chapter is intended to provide an ADHC Waiver provider with the information necessary to fulfill its vendor contract with the State of Louisiana, and is the basis for federal and In the Basic Services Training Manual or visit the LDH website Parish Offices page. The Louisiana Department of Health protects and promotes health and ensures access to medical, Managed Care Organization (MCO) Manual is a compilation of policies, instructions, and guidelines established by the Louisiana Department of Health (LDH) for the administration of the Louisiana Medicaid managed care program. Issued June 10, 2011 . 06/22/2022. Issued March 23, 2011 . Customer Service . If you are in a Medicaid health plan, you should know: Your pharmacy benefits and co-pays are not changing. References in this manual to ICD-9 diagnosis codes only apply to claims/authorizations with dates of service prior to October 1, LOUISIANA MEDICAID PROGRAM ISSUED: 09/24/21 REPLACED: 06/01/20 CHAPTER 5: PROFESSIONAL SERVICES SECTION 5. Manual. Applicants for ** Medicaid assistance can be considered for Manual. Number of . H-810. This Manual also applies to major subcontractors with January 1, 2023 Louisiana Medicaid Eligibility Manual Eligibility Determinations Issued April 29, 2024 Page 1 of H-1800 Replacing July 07, 2022 Revised/added text indicated by underscore Deleted text indicated by “**” H-1800 RETROACTIVE MEDICAL ELIGIBILITY (RME) H-1810 GENERAL INFORMATION. 1 Early and Periodic Screening, Diagnostic and Treatment (EPSDT) (See Appendix A for information on how to access this manual). Member Services: (844) 234-9834. Issued April 1, 2011 . If a recipient comes back with a retroactive Medicaid card, Louisiana Medicaid reimburses providers who are enrolled in the Louisiana Medicaid Program, Louisiana Medicaid. 10 1 LA-22-10-02 Revised 01-22-2024 e Provider Manual Provider Experience Department: 1-855-242-0802 AetnaBetterHealth. Claims/authorizations for dates of service on or after October 1, 2015 LOUISIANA MEDICAID PROGRAM ISSUED: 09/09/24 REPLACED: 09/13/21 CHAPTER 9: ADULT DAY HEALTH CARE WAIVER SECTION: TABLE OF CONTENTS PAGE(S) 4 2023 Provider Manual Humana Healthy Horizons® in Louisiana is a Medicaid product of Humana Health Benefit Plan of Louisiana Inc. 19] Page 6 of 217 19. Press Enter. Claims/authorizations for dates of service on or after October 1, 2015 participation in the Louisiana Medicaid program and supplement current licensing requirements applicable to ICF/IIDs. 0: OVERVIEW PAGE(S) 2 Page 1 of 2 Section 7. Louisiana Medicaid Eligibility Manual Renewals Reissued July 16, 2024 Replacing July 11, 2023 Page 1 of K-0000 Revised/added text indicated by underscore Deleted text indicated by “**” K-0000 RENEWALS K-100 REQUIREMENTS . 342. The MCO shall have written procedures for EPSDT preventive services in compliance with 42 C. 9500 | Fax Residential Treatment, refer to the Louisiana Medicaid UM Guideline: • Substance Use Disorder: Residential Treatment Facility Louisiana Behavioral Health Provider Manual (“LBHPM”), Addiction Services: The Louisiana Behavioral Health Provider Manual (LBHPM) is the basis for all medically necessary decisions in Louisiana. Providers with multiple provider types must complete This Manual applies to MCOs contracted by LDH to provide coverage for services to Louisiana Medicaid managed care program enrollees, effective January 1, 2021. 01/16/2019. It is the Chapter Forty-Six of the Medicaid Services Manual . Issued April 15, 2012 . The purpose of this Manual is to provide clarifying information and operational guidelin es Chapter Thirty-Six of the Medicaid Services Manual . We have over 30 years of experience serving Medicaid populations, including children, adults PROVIDER MANUAL Chapter Ten of the Medicaid Services Manual Issued November 1, 2010 State of Louisiana Bureau of Health Services Financing. and the Louisiana Medicaid provider manuals linked below. The SC will: Louisiana Medicaid has adopted the following policy concerning HMO/Medicaid coverage based on HCFA clarification. Provider Manuals. 9500 | Fax 37. This Policy is used to determine eligibility for coverage in Louisiana Medicaid Programs. Hospitals EXCLUDING Long-Term Acute Care, Freestanding Psychiatric, and Freestanding Rehabilitation Hospitals neonatal per diem rates as defined in Louisiana’s Medicaid State Plan. These claims must be submitted hard copy with a copy of the HMO Explanation of Benefits from the carrier that is on file with the state; Chapter Forty-three of the Medicaid Services Manual . References in this manual to ICD-9 diagnosis codes only apply to claims/authorizations with dates of service prior to October 1, schedules, and not covered in the Louisiana Medicaid The MCO shall consult LDH with any State Plan. This Manual MCNA is a Medicaid and CHIP dental plan for the entire state of Louisiana. We have built a national oral health ecosystem committed to quality patient care, efficient processes and continuous improvement on the fundamentals to help your Louisiana Provider Manual MCNA Dental MCNA_LA-P_PM[1. LOUISIANA MEDICAID PROGRAM ISSUED: 07/01/10 REPLACED: CHAPTER 15: PSYCHOLOGICAL BEHAVIORAL SERVICES SECTION 15. PACKET/CHECKLIST (Louisiana Medicaid Program) Supervised. O. LOUISIANA MEDICAID PROGRAM ISSUED: 12/01/10 LOUISIANA MEDICAID PROGRAM ISSUED: 12/01/10 REPLACED: CHAPTER 9: ADULT DAY HEALTH CARE WAIVER SECTION 9. Date Section ; Section Title . 14. 4th Street | Baton Rouge, LA 70802 | PHONE: 225-342-9500 | FAX: 225-342-5568 Medicaid Customer Service 1-888-342-6207 | Healthy Louisiana 1-855-229-6848 Louisiana Medicaid . MAINTENANCE NEEDS and RESOURCE STANDARDS . SUPPORTS WAIVER . Louisiana Medicaid Eligibility Manual Medical Services Reissued August 20, 2024 Replacing May 30, 2023 Page 1 of C-0000 Revised/added text indicated by underscore Deleted text indicated by “**” C-0000 MEDICAL SERVICES The following is a brief overview of medical services covered by Medicaid. The Louisiana Department of Health protects and promotes health and ensures access to medical, preventive and rehabilitative services for all citizens of the State of Louisiana. Medicaid provides health care benefits to low-income individuals and families. REQUIRED Enter an X in the box marked Medicaid (Medicaid #) *1A. 4th Street | Baton Rouge, LA 70802 | PHONE: 225-342-9500 | FAX: 225-342-5568 Medicaid Customer Service 1-888-342-6207 | Healthy Louisiana 1-855-229-6848 Manual. Claims/authorizations for dates of service on or after October 1, 2015 LOUISIANA MEDICAID PROGRAM ISSUED: 06/10/24 REPLACED: 01/20/23 CHAPTER 35: PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY LOUISIANA MEDICAID PROGRAM NEW OPPORTUNITY WAIVER CHAPTER 32 ISSUE DATE JANUARY 1, 2004 Services identified in this manual are provided under the New Opportunities Waiver (NOW), based on need; and must be specified in the BCSS approved Comprehensive Plan of Care (CPOC). If you have questions about the information or materials in this manual, or about out policies, please call Provider Services at 1-866-675-1607. The Louisiana Department of Health (LDH) determines who is an authorized user defining all user access capabilities. 6: RECORD KEEPING PAGE(S) 7 Record Keeping Page 6 of 7 Section 2. 3. Claims/authorizations for dates of service on or after October 1, 2015 must use the applicable ICD-10 diagnosis code that reflects the policy intent. GET MORE INFORMATION. 03/02/2020. PT-89 Supervised Independent Living (SIL) Rev. MEDICAID OF LOUISIANA CHAPTER 22 MEDICAL SERVICES MANUAL LOUISIANA POS USER MANUAL ISSUED MARCH 1, 1996 22-9 III. Any prescriptions or Louisiana Medicaid Eligibility Manual Eligibility Determinations Issued September 23, 2024 Page 2 of H-100 Replacing March 21, 2022 Revised/added text indicated by underscore Deleted text indicated by “**” o Family Opportunity Act Medicaid Buy-In Program (FOA), for children with disabilities and family gross income at or not be a separate Dental card for UnitedHealthcare Medicaid and Medicare plans . 1 Mailing: Louisiana Department of Health | P. 0: NEMT Mailing: Louisiana Department of Health | P. %PDF-1. Definitions . Reissued April 14, 2022 Replacing July 1, 2014 Page 2 of H-3300 Revised/added text indicated by underscore Deleted text indicated by “**” that considered by SSA in making its determination, or • claims that his or her condition has deteriorated and it has Louisiana Medicaid Eligibility Manual Charts Issued May 10, 2021 Page 1 of Z-1300 Replacing April 1, 1992 Revised/added text indicated by underscore Deleted text indicated by “**” USUFRUCT AND REMAINDER INTEREST TABLES . Issued September 27, 2012 . The ID cards are customized with the UnitedHealthcare logo and include the toll-free customer service number for the health plan . Issued April 21, 2011 . 11/01/2021 1. To enroll your dental office in our Louisiana Medicaid and CHIP network, please follow the steps listed below. 1-888-342-6207. Table of Contents | Page i . LOUISIANA DEPARTMENT OF HEALTH . This includes the population made eligible as part of the Louisiana Affordable Care Act (ACA) Medicaid expansion. 1: COVERED SERVICES PAGE(S) 10 EPSDT Page 1 of 10 Section 5. 7 million enrollees, approximately 37 percent of the state’s population. 2,917 likes · 93 talking about this · 1 was here. The recipient must use the services of the HMO which they freely choose to join . 05/22/2019. Long-term care patient liability income changes. State Plan, state statutes, administrative rules, and Medicaid policy and procedure manuals, these managed care entities . MCNA is a Medicaid and CHIP dental plan for the entire state of Louisiana. In addition, some sections of the primary National Network Manual are repeated for convenience Louisiana Medicaid Home About Us Provider Tools Portal Enrollment Status have been incorporated into the manual chapter. 6848. Pages replaced from 10/07/24 revision . 6 and clinically appropriate. Louisiana Medicaid Managed Care Quality Strategy Evaluation Page 4 of 31 this manual. This Manual applies to DBPMs contracted by LDH to provide coverage for services to Louisiana Medicaid ental d program enrollees, effective March 1, 2022. NOW services are provided as a supplement to Chapter Eighteen of the Medicaid Services Manual . An enrolled Medicaid provider is entitled to a provider manual for the specific program in which he or she DentaQuest is a leading dental insurance provider in Louisiana, providing dental coverage to eligible members of various Medicaid, Medicare Advantage, Marketplace and Personal plans. Chapter Nine of the Medicaid Services Manual . GETTING STARTED Pharmacy providers participating in the Louisiana Medicaid Point of Sale system should contact their computer system vendor for further information. This Manual also applies to major subcontractors with delegated responsibilities for the provision of all, or part, of any program area or function that relates to the References in this manual to ICD-9 diagnosis codes only apply to claims/authorizations with dates of service prior to October 1, 2015. Issued March 21, 2023 Page 1 of Z-1200 Replacing January 20, 2021 . 1 - Provider Requirements for additional information of record keeping. Bureau of Health Services Financing. This manual chapter provides the minimum service requirements for the Professional Services Program. 2 PHARMACY PROVIDER ENROLLMENT AND PARTICIPATION 2-1 GUIDELINES Providers should refer to Chapter 3 and 4 of the Louisiana Medicaid Program Provider Manual for additional information on Provider Enrollment and Requirements, including General Standards for Participation. Independent Living (SIL) Section under Covered Services in the Louisiana Medicaid Program CCW Provider Manual. 12 – Patient Counseling and Drug Utilization Review (DUR) Louisiana Medicaid Preferred Drug List (PDL) and Non-Preferred Drug List (NPDL) Pages replaced from 01/28/2022 revision – Section 37. Chapter Sixteen of the Medicaid Services Manual . Medicaid ID cards issued by the state of Louisiana do not guarantee payment under the UnitedHealthcare Medicaid plans . Issued May 1, 2012 . Z-800 * The maximum maintenance needs allowance for each dependent can be no more than Mailing: Louisiana Department of Health | P. This Manual also applies to major The following is a list of the specific programs and services offered under Louisiana Medicaid. questions about these requirements. Average Number of Years of Life Remaining : Age : Average Number of Years of Life Remaining . Age Usufruct Remainder Age Usufruct Remainder 0 . 12/14/23 . The Community Choices Waiver (CCW) is a Medicaid Home and Community-Based Services Medicaid Services Manual located on the Louisiana Medicaid website (below) LOUISIANA MEDICAID PROGRAM ISSUED: 12/14/23 REPLACED: CHAPTER 2: BEHAVIORAL HEALTH SERVICES Chapter 2 Behavioral Health Services Revision History Log REVISION HISTORY LOG . Healthy Blue (Amerigroup) Refer to Medicaid Services Manual, Behavioral Health Services. follows the guidelines published in the most current version of the Louisiana References in this manual to ICD-9 diagnosis codes only apply to claims/authorizations with dates of service prior to October 1, 2015. This Manual also applies to major subcontractors with delegated responsibilities for the provision of all, or part, of any program area or function that relates to the Mailing: Louisiana Department of Health | P. Verify all last illness and burial expenses. 6 – Prescribers. 5: PROVIDER REQUIREMENTS PAGE(S) 7 Election of Hospice Care of this manual chapter). 9500 | Fax Louisiana Medicaid Eligibility Manual Eligibility Factors . Your Provider Manual includes detailed information about Louisiana Medicaid and CHIP, including covered services, submission requirements for claims and prior authorizations, dental guidelines, provider This Manual applies to DBPMs contracted by LDH to provide coverage for services to Louisiana Medicaid dental program enrollees, effective March 1, 2022. The Medicaid Services Manual has been developed to present useful information and guidance to providers participating in the Louisiana Medicaid Eligibility for enrollment in the Louisiana Medicaid Program is available to individuals who are determined eligible for Louisiana Medicaid and the LaCHIP Programs and who belong to The Medicaid Eligibility Manual is written as a guide for the Agency Representative to determine Medicaid eligibility. References in this manual to ICD-9 diagnosis codes only apply to established by the Louisiana Department of Health (LDH) for the administration of the Louisiana Medicaid managed care program. 1: COVERED SERVICES PAGE(S) 7 Page 3 of 7 Section 9. Background: The Louisiana Department of Health (LDH) published the chapter of the Behavioral Health Services Provider Manual associated This Manual applies to MCOs contracted by LDH to provide coverage for services to Louisiana Medicaid managed care program enrollees, effective January 1, 2021. Issued October 1, 2010 . Issued October 18, 2013 . Providers may contract with outside laboratories to perform these lab procedures. LOUISIANA MEDICAID PROGRAM ISSUED: 03/22/21 REPLACED: 05/16/19 CHAPTER 30: PERSONAL CARE SERVICES SECTION 30. 9500 | Fax The following is a list of the specific programs and services offered under Louisiana Medicaid. Issued March 15, 2012 . O. 4th Street | Baton Rouge, LA 70802 | Phone: 225. 9500 | Fax Chapter Twenty-Nine of the Medicaid Services Manual . 1 excluding expenses for room and . Rather, this Louisiana Medicaid manual supplements the primary National Network Manual by focusing on the core service array, roles and responsibilities, as well as processes and procedures specific to the State of Louisiana Medicaid programs. In addition, some sections of the primary National Network Manual are repeated for convenience Mailing: Louisiana Department of Health | P. Services provided by a nurse practitioner that are medical in nature must be reasonable and necessary, be included in the POC and must be services that, in the Aetna Better Health of Louisiana is part of Aetna®, one of the nation's leading health care providers and a part of the CVS Health® family. GENERAL INFORMATION . Get contact information, plan details, benefit summaries and more. Published 4/1/2022 . Louisiana Medicaid Eligibility Manual Eligibility Factors Reissued September 23, 2024 Page 4 of I-1630 Replacing June 02, 2023 Revised/added text indicated by underscore Deleted text indicated by “**” resource limit, SSI benefits are suspended until the resources are reduced below the SSI limit. 9500 | Fax LOUISIANA MEDICAID PROGRAM ISSUED: 01/01/19 REPLACED: 07/01/13 CHAPTER 7: COMMUNITY CHOICES WAIVER SECTION 7. Evaluation of the evidence-base for the TF-CBT model has been conducted by national LOUISIANA MEDICAID PROGRAM ISSUED: 08/26/21 REPLACED: 04/22/20 CHAPTER 2: BEHAVIORAL HEALTH SERVICES APPENDIX E-9: EVIDENCED BASED PRACTICES (EBPs) POLICY – Louisiana Medicaid Home About Us Provider Tools Portal Enrollment Status Fee-for-Service Provider Enrollment Provider Manuals AMERICAN INDIAN 638 CLINICS Manual Issued December 1, 2009. Age . Louisiana Medicaid Eligibility Manual Eligibility Factors Issued July 31, 2024 Page 1 of I-1530 Replacing August 1, 2024 Deleted text indicated by “” Revised/added text indicated by underscore I-1530 NEED – SSI-RELATED INCOME I-1531 INCOME UNIT The income unit is the individual or group of individuals whose income Centers for Medicare and Medicaid Services (CMS), LDH and other st ate agencies if applicable; and • Comply with all of the terms and conditions for Medicaid enrollment. This A provider must be enrolled in the Medicaid Program and meet the provider qualifications at the time service is rendered to be eligible to receive reimbursement through the Louisiana Provider manuals. Box 629 | Baton Rouge, LA 70821-0629 Physical Address: 628 N. If manual not received within two (2) weeks of notification, please contact Provider Relations at This manual is for use by hospitals that have electedto participate in the Hospital Presumptive Eligibility (HPE) determination process for Louisiana’s Medical Assistance notify Louisiana Medicaid of its election to make HPE determinations in the following eligibility categories: Dependent childrenunder age 19, Pregnant State Directed Payment Program Manual . Claims/authorizations for dates of service on or after October 1, 2015 LOUISIANA MEDICAID PROGRAM ISSUED: 06/30/22 REPLACED: 03/03/20 CHAPTER 40: RURAL HEALTH CLINICS SECTION: TABLE OF CONTENTS PAGE(S) 3 Click on a date to see the manual chapter page(s) prior to the revision. Annuity – a contract or agreement by which one receives fixed this manual. Louisiana Medicaid: Access Your Health Plan ID Cards Anytime with LA Wallet. 6207 | Healthy Louisiana: 1. 09/09/2024. 2: LT-PCS - COVERED SERVICES PAGE(S) 5 Louisiana Medicaid currently serves nearly 1. Chapter Thirty of the Medicaid Services Manual. LOUISIANA MEDICAID PROGRAM ISSUED: 11/01/2010 REPLACED: 01/01/1998 CHAPTER 10: MEDICAL TRANSPORTATION_____ SECTION: 10. Molina Medicaid Solutions P. 232] Page 2 of 276 Table of Contents 1. Claims/authorizations for dates of service on or after October 1, 2015 LOUISIANA MEDICAID PROGRAM ISSUED: 08/10/22 REPLACED: 09/21/21 DentaQuest has updated the document to provider direct links to web portals and other direct locations for providers. I-1710 GENERAL INFORMATION . 06132 Mailing Address: Louisiana Department of Health | P. This Manual also applies to major subcontractors with delegated responsibilities for the provision of all, or part, of any program area or function that relates to the Louisiana Provider Manual MCNA Dental MCNA_LA-P_PM[1. Humana Healthy Horizons® in Louisiana is a Medicaid product of Humana Health Benefit Plan of Louisiana Inc. 8: LT-PCS - RECORD KEEPING PAGE(S) 7 Mailing: Louisiana Department of Health | P. 9500 | Fax DentaQuest has updated the document to provider direct links to web portals and other direct locations for providers. Aetna Medicaid. E-Medicaid Eligibility Verification System (E-MEVS exist between manual chapter material and pertinent laws or regulations governing the Louisiana Medicaid Program, the latter will take precedence. 05/07/2024. Medicaid Eligibility Verification System (MEVS) . The intent of the provider services manual is to present useful information and guidance to providers participating in the Louisiana Medicaid Program. Louisiana Medicaid beneficiaries underscores its support of The Louisiana Medicaid Provider Login User Manual has been developed for Louisiana Medicaid Providers to navigate through a First Time Log In as a New or Existing User. Evaluation of the evidence-base for the TF-CBT model has been conducted by national LOUISIANA MEDICAID PROGRAM ISSUED: 08/26/21 REPLACED: 04/22/20 CHAPTER 2: BEHAVIORAL HEALTH SERVICES APPENDIX E-9: EVIDENCED BASED PRACTICES (EBPs) POLICY – Chapter Forty-Three of the Medicaid Services Manual . References in this manual to ICD-9 diagnosis codes only apply to This Manual applies to MCOs contracted by LDH to provide coverage for services to Louisiana Medicaid managed care program enrollees, effective January 1, 2021. References in this manual to ICD-9 diagnosis codes only apply to Managed Care Organization (MCO) Manual is a compilation of policies, instructions, and guidelines established by the Louisiana Department of Health (LDH) for the administration of the Louisiana Medicaid managed care program. UnitedHealthcare Community Plan of Louisiana Care Provider Manual Mailing Address: Louisiana Department of Health | P. 9500 | Fax LOUISIANA MEDICAID PROGRAM ISSUED: 02/07/22 REPLACED: 08/25/21 CHAPTER 24: HOSPICE SECTION 24. Issued July 16, 2024 Replaced January 23, 2023 Page 1 of G-0000 . and 4:30 p. Healthy Blue serves populations covered under Healthy Louisiana. F. Revised/ Issued . ) Informational Bulletin 18-13: Informational Bulletin 18-4: 2018 Louisiana Medicaid EPSDT Periodicity Schedule (Made obsolete by IB 20-23) Informational Bulletin 18-3: Open Enrollment for Chapter Twenty-Six of the Medicaid Services Manual . Author: HaasGeor Created Date: 4/15/2024 8:54:42 AM We are here to help you understand your benefits, so you can make the most of your Louisiana Medicaid dental coverage. Directions for establishing a valid online provider account Mailing: Louisiana Department of Health | P. Issued June 2, 2023 Page 2 of I-1600 Replacing February 28, 2020 Revised/added text indicated by underscore Deleted text indicated by “**” value of the resource continues to be countable or becomes countable (e. 09/13/2021. The Provider Enrollment Portal remains open for providers required to enroll who have not yet applied. 95 Mailing: Louisiana Department of Health | P. The Healthy Blue Medicaid Managed Care Provider Manual provides key administrative information, including the quality improvement program, the UM program, quality standards for participation, claims appeals, and reimbursement and administration policies. Issued November 1, 2010 . A -by-step process of the current step We are here to help you understand your benefits, so you can make the most of your Louisiana Medicaid dental coverage. A -by-step process of the current step Chapter Two of the Medicaid Services Manual Issued March 14, 2017 State of Louisiana Bureau of Health Services Financing. Imminent peril is defined as sudden, urgent and critical situations that call for aid to the public In Louisiana, when a Medicaid member becomes incarcerated, they do not lose Medicaid eligibility. LOUISIANA MEDICAID PROGRAM ISSUED: 08/06/21 REPLACED: 09/19/13 CHAPTER 46: VISION (EYE WEAR) SERVICES LOUISIANA MEDICAID PROGRAM ISSUED: 08/06/21 Chapter Forty of the Medicaid Services Manual . This Manual also applies to major subcontractors with delegated responsibilities for the provision of all, or part, of any program area or function that relates to the delivery or Louisiana Community Psychiatric Subject: Support and Treatment Current Effective Date: 02/23/2017 Status: Active Last Review Date: 5-11-2021 Pending Page 4 of 12 [See Louisiana Behavioral Health Services Provider Manual (BHSPM), LOUISIANA MEDICAID PROGRAM ISSUED: 06/20/20 REPLACED: 04/08/20 CHAPTER 2: BEHAVIORAL HEALTH Louisiana Medicaid Eligibility Manual Eligibility Factors Reissued August 30, 2024 Page 6 of I-1670 Replacing April 2, 2024 Revised/added text indicated by underscore Deleted text indicated by “**” holder retains the power to sell the property, its value as a resource is its full equity value because nothing of value was %PDF-1. Each service/progress note must document the specific interventions delivered (Louisiana Medicaid Program) Pre-Vocational Habilitation (Enrollment packet is subject to change without notice. Medicaid Customer Service 1-888-342-6207 | Healthy Louisiana 1-855-229-6848. Section 1. Find operational policy changes and other electronic Chapter Twenty-Seven of the Medicaid Services Manual . Z-1200 . We administer the dental benefits for eligible children enrolled in the EPSDT Program and adults enrolled in the Adult Denture Program or the Adult Waiver Program. 5 for more information on PA. The manual is divided into two Louisiana Medicaid program: o The Louisiana Medicaid EPSDT screening guidelines and policies apply to individuals under 21 years of age; and o The Louisiana Medicaid schedule Managed Care Organization (MCO) Manual is a compilation of policies, instructions, and guidelines established by the Louisiana Department of Health (LDH) for the provided to Medicaid beneficiaries are medically necessary, appropriate and within the scope of current medical practice and Medicaid guidelines. , dis -enrolled) from their health plan in order to prevent improper Medicaid payments. 02/09/2024. Chapter Seventeen of the Medicaid Services Manual . 2 to provide services to Louisiana Medicaid beneficiaries underscores its support of Louisiana’s ongoing Triple Aim focus. Claims/authorizations for dates of service on or after October 1, 2015 providers must meet in order to qualify for reimbursement under the Louisiana Medicaid program. . Louisiana Medicaid Fee Schedules; Hospital Provider Per Diem Rates Mailing Address: Louisiana Department of Health | P. Issued March 14, 2017 . 8% Chapter Fifteen of the Medicaid Services Manual Issued July 1, 2009 State of Louisiana Bureau of Health Services Financing. 02812 35 . 9500 | Fax In Louisiana, when a Medicaid member becomes incarcerated, they do not lose Medicaid eligibility. 4th Street | Baton Rouge, LA 70802 | PHONE: 225-342-9500 | FAX: 225-342-5568 Medicaid Customer Service 1-888-342-6207 | Chapter Fourteen of the Medicaid Services Manual . Selected as a high Medicaid utilization service; Louisiana has the nation’s largest percentage of births (62. 4 ADDICTION SERVICES PAGE(S) 64 (Refer to the sections of this manual chapter on inpatient and outpatient hospitals for definition, qualifications, and requirements). Pages replaced from 06/17/2022 revision – Section 37. Dental Benefit Program Manager (DBPM) Manual . LOUISIANA MEDICAID PROGRAM ISSUED: 11/01/09 REPLACED: 11/01/07 CHAPTER 30: MENTAL HEALTH REHABILITATION SECTION 30. 5. 1 Early and Periodic Screening, Diagnostic and Treatment (EPSDT) The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program is a comprehensive benefit This Manual is intended to accompany the Contract rather than be a standalone and exhaustive compilation of contractual requirement s. Revised/added text indicated by underscore Deleted text indicated by “**” I-1700 TRUSTS . Endodontic Therapy Services. Annuity – a contract or agreement by which one receives fixed Mailing: Louisiana Department of Health | P. Table of Contents. SC will discuss with participant to ensure that the EAA will align with their identified goals. Applicants for ** Medicaid assistance can be considered for Mailing: Louisiana Department of Health | P. This chapter consists of several sections Rather, this Louisiana Medicaid manual supplements the primary National Network Manual by focusing on the core service array, roles and responsibilities, as well as The Medicaid Services Manual contains information about Medicaid fee -for-service benefits. August 16, 2024. 855. 888. NOTE: Documentation for EAA may suggest that the EAA is not necessary, but helpful to the participant’s overall functioning level. State of Louisiana . This Manual also applies to major subcontractors with delegated responsibilities for the provision of all, or part, of any program area or function that relates to the Louisiana Medicaid Eligibility Manual Eligibility Determinations Issued April 29, 2024 Page 1 of H-1800 Replacing July 07, 2022 Revised/added text indicated by underscore Deleted text indicated by “**” H-1800 RETROACTIVE MEDICAL ELIGIBILITY (RME) H-1810 GENERAL INFORMATION. 5 Medicaid Management Information System (MMIS) 1-4 37. ) Informational Bulletin 18-13: Informational Bulletin 18-4: 2018 Louisiana Medicaid EPSDT Periodicity Schedule (Made obsolete by IB 20-23) Informational Bulletin 18-3: Open Enrollment for Louisiana Community Psychiatric Subject: Support and Treatment Current Effective Date: 02/23/2017 Status: Active Last Review Date: 5-11-2021 Pending Page 4 of 12 [See Louisiana Behavioral Health Services Provider Manual (BHSPM), LOUISIANA MEDICAID PROGRAM ISSUED: 06/20/20 REPLACED: 04/08/20 CHAPTER 2: BEHAVIORAL HEALTH State Directed Payment Program Manual . This Manual applies to MCOs contracted by LDH to provide coverage for services to Louisiana Medicaid managed care program enrollees, effective . Providers should refer to the General Information and Administration manual chapter of the Medicaid Services Manual located on the Louisiana Medicaid website. 8% Louisiana Medicaid Eligibility Manual Eligibility Factors Issued July 31, 2024 Page 9 of I-1530 Replacing August 1, 2024 Deleted text indicated by “” Revised/added text indicated by underscore • Funeral, burial plot, and interment expenses, and • Other related expenses. Revised/added text indicated by underscore Deleted text indicated by “**” G-0000 APPLICATION PROCESSING . Healthy Call Louisiana Medicaid Customer service at 1-888-342-6207, between the hours of 8 a. 9500 | Fax Louisiana Department of Health (LDH) Applied Behavior Analysis Provider Manual to determine the medical necessity of outpatient Applied Behavior Analysis (ABA) services for Louisiana Medicaid covered applied behavior analysis (ABA)-based therapy is the design, implementation, and licensed by the Louisiana Behavior Analyst Board, or a Louisiana Provider Manual MCNA Dental MCNA_LA-P_PM[1. 9500 | Fax LOUISIANA MEDICAID PROGRAM ISSUED: 02/28/23 REPLACED: 01/27/23 CHAPTER 18: DURABLE MEDICAL EQUIPMENT SECTION 18. m. Medicaid eligibility continues during Louisiana Medicaid Unisys Corporation Provider Enrollment PO Box 80159 (225) 216-6370 Baton Rouge, LA 70898-0159 forward a provider manual to you. g. 2 Table of contents . Louisiana Medicaid Eligibility Manual Application Processing . The purpose of this Manual is to provide clarifying information and operational guidelin es For Medicaid Providers. 9500 | Fax This Manual applies to MCOs contracted by LDH to provide coverage for services to Louisiana Medicaid managed care program enrollees, effective January 1, 2021. This Manual also applies to major subcontractors with delegated responsibilities for the provision of all, or part, of any program area or function that relates to the delivery or Louisiana Medicaid require prior authorization (PA) by the Prior Authorization Unit (PAU). The Centers for Medicare and Medicaid Services (CMS) federal regulations, including the Affordable Care Act and the 21st Century Cures Act, require providers who file claims with Louisiana Medicaid to enroll in Medicaid's web-based provider enrollment portal. com/Louisiana Aetna Better Health® of Louisiana Molina Medicaid Solutions P. This means Magellan will handle authorizations, claims and prescription coverage for all Medicaid health plan members. Box 629 | Baton Rouge, LA 70821-0629 Physical: 628 N. LAHLQG9EN P7374LA0722 . 02 Mailing: Louisiana Department of Health | P. Claims/authorizations for dates of service on or after October 1, 2015 LOUISIANA MEDICAID PROGRAM ISSUED: 06/30/22 REPLACED: 03/03/20 CHAPTER 40: RURAL HEALTH CLINICS SECTION: TABLE OF CONTENTS PAGE(S) 3 Refer to Medicaid Services Manual, Behavioral Health Services. Medicaid Provider Enrollment Portal. If you need help completing the steps in the letter or if you This Manual applies to MCOs contracted by LDH to provide coverage for services to Louisiana Medicaid managed care program enrollees, effective January 1, 2021. References in this manual to ICD-9 diagnosis codes only apply to Louisiana Medicaid Eligibility Manual Eligibility Factors . 9500 | Fax Mailing: Louisiana Department of Health | P. LOUISIANA MEDICAID PROGRAM ISSUED: 04/30/24 REPLACED: 01/01/23 CHAPTER 2: BEHAVIORAL HEALTH SERVICES SECTION: TABLE OF CONTENTS PAGE(S) 11 The Louisiana Department of Health protects and promotes health and ensures access to medical, preventive and rehabilitative services for all citizens of the State of Louisiana. 95 Louisiana Medicaid Eligibility Manual Eligibility Determinations . This Manual also applies to major subcontractors with Mailing: Louisiana Department of Health | P. Chapter Twenty-Four of the Medicaid Services Manual . 1: COVERED SERVICES PAGE(S) 7 Louisiana Medicaid Eligibility Manual Eligibility Factors . This Manual also applies to major subcontractors with delegated responsibilities for the provision of all, or part, of any program area or function that relates to the Louisiana Medicaid Home About Us Provider Tools Portal Enrollment Status Fee-for-Service Provider Enrollment Fraud and Abuse MEVS Click on a date to see the manual chapter page(s) prior to the revision. August 05, 2024. 02 LOUISIANA MEDICAID PROGRAM ISSUED: 08/26/21 REPLACED: 01/01/20 CHAPTER 2: BEHAVIORAL HEALTH SERVICES SECTION 2. Any infraction of these standards be considered a violation of the will Mailing Address: Louisiana Department of Health | P. Federal regulations require that the agency periodically review the eligibility of Medicaid beneficiaries. REQUIRED Enter the recipient s 13 digit Medicaid ID number exactly as it appears in the recipient s current Medicaid information using the plastic Medicaid swipe card (MEVS), e-MEVS, or through REVS Mailing: Louisiana Department of Health | P. 1. 0 Overview. Revised/added text indicated by underscore Deleted text indicated by “**” LIFE EXPECTANCY TABLE – MALES . In adhering to Early and Periodic Screening, Diagnosis and Treatment (EPSDT) requirements, DME items whether or not listed in this manual or on the DME fee schedule will be considered This Manual applies to MCOs contracted by LDH to provide coverage for services to Louisiana Medicaid managed care program enrollees, effective January 1, 2021. 97188 . 03/17/2021. 0 OVERVIEW. 2: SPECIFIC COVERAGE CRITERIA PAGE(S) 8 A variable height hospital bed is one with manual height adjustment and manual head and leg elevation adjustments. To simplify the process, UnitedHealthcare Community Plan of Louisiana has partnered with Louisiana Medicaid for a provider enrollment drive that will devote time to each provider type over the next few months. Issued March 1, 2011 . Louisiana Louisiana Office of Management and Finance (Bureau of Health Services Financing) - Medicaid . Healthy Blue (Amerigroup) In fall 2021, Louisiana Medicaid mailed letters to providers about this enrollment requirement. 93868 . 01/01/2019 The UnitedHealthcare Community Plan of Louisiana Physician, Health Care Professional, Facility and Ancillary Care Provider Manual applies to the following plans: UnitedHealthcare Community Plan of Louisiana - Healthy Louisiana; Care Provider Manuals. Chapter Thirty-Two of the Medicaid Services Manual . 9500 | Fax PROVIDER MANUAL. MyMedicaid@la. Chapter Nine of the Medicaid Services Manual Issued December 1, 2010 State of Louisiana Bureau of Health Services Financing. 05/2024 . Chapter Thirty-Five of the Medicaid Services Manual . 2. Refer to section 18. Section 39. This Manual applies to MCOs contracted by LDH to provide coverage for services to Louisiana Medicaid managed care program enrollees, effective January 1, 2021. Developmental Screening . 4: RECORD KEEPING PAGE(S) 5 PAGE(S) 1 This Manual is intended to accompany the Contract rather than be a standalone and exhaustive compilation of contractual requirements. References in this manual to ICD-9 diagnosis codes only apply to claims/authorizations with dates of service prior to October 1, 2015. To view the manual chapter page(s) prior to revision, return to the "Obsolete Pages" link. View All News. Mailing: Louisiana Department of Health | P. 1 Coverage 2023 Provider Manual . Health Plan Relations Louisiana Provider Manual policy: pdf: performance management/reporting and evaluation management pm-rem al-02-2013, dma administrative letter no: 03-2013, daas administrative letter no: 2013-05, dss economic and family services administrative letter no: 03-2013, dcdee administrative letter no: 01-2013, online verification (olv) enhancements LOUISIANA MEDICAID PROGRAM ISSUED: 10/13/21 REPLACED: 03/04/20 CHAPTER 30: PERSONAL CARE SERVICES APPENDIX A – LT-PCS FORMS AND LINKS PAGE(S) 2 _____ Forms and Links Page 1 of 2 Appendix A. 13. LAHLQG9EN P7374LA0722. TABLE OF CONTENTS . Louisiana Provider Manual MCNA Dental MCNA_LA-P_PM[1. LDH invites public comment on Reentry 1115 Demonstration Waiver application. G-100 INTRODUCTION Chapter Nine of the Medicaid Services Manual . PROVIDER TYPE SPECIFIC. e. Medicaid Plans by State, click on Louisiana Easily find information in this care provider manual using the following steps 1. Type in the keyword. Evaluation of the Evidence Base for the EBP Model . 9500 | Fax LOUISIANA MEDICAID PROGRAM ISSUED: 08/26/21 REPLACED: 05/29/20 CHAPTER 2: BEHAVIORAL HEALTH SERVICES SECTION 2. ) PT-13 Rev. It is applied to determine eligibility for new applications and for on-going coverage. LT-PCS FORMS AND LINKS . Issued September 1, 2010 . August 12, 2024. R. Issued May 09, 2023 Page 1 of I-1700 Replacing February 08, 2017 . STEP 2: Look for mail from Louisiana Medicaid and follow the instructions. Issued November 1, 2009 . Box 91020 Baton Rouge, LA 70821 *1. 11/09/2019. Medicaid Provider Manuals Table of Contents Chapter 1: General Information & Administration Chapter 2: Behavioral Health Services Chapter 3: Fiscal/Employer Agent (F/EA) Chapter 4: Applied Behavior Analysis (ABA) Chapter 5: Professional Services Chapter 7: Community Choices Waiver (CCW) Louisiana Medicaid Eligibility Manual Eligibility Determinations Issued September 23, 2024 Page 2 of H-100 Replacing March 21, 2022 Revised/added text indicated by underscore Deleted text indicated by “**” o Family Opportunity Act Medicaid Buy-In Program (FOA), for children with disabilities and family gross income at or This Manual applies to DBPMs contracted by LDH to provide coverage for services to Louisiana Medicaid dental program enrollees, effective March 1, 2022. Issued July 1, 2011 . LOUISIANA MEDICAID PROGRAM ISSUED: 10/07/24 REPLACED: 08/08/23 CHAPTER 43: SUPPORTS WAIVER SECTION: TABLE OF CONTENTS PAGE(S) 4 Page 1 of 6 Table of Contents. gov . The purpose of this Manual is to provide clarifying information and o perational guidelin es to support the MCO in complying with the terms of its contract with LDH (hereinafter, the “Contract”) . 11. During this time, we will be sharing Louisiana Medicaid Eligibility Manual Charts. sale of excluded home property for cash). uzvdejs erv zdnh ywvtny mchc iqvkd mdhdf gdjzvkj nhcy mpkc