Health Plan Advisories

HPA 21-03: Bipartisan Budget Act of 2018 and Changes to Medicaid Provisions for “Pay and Chase” Passed April 2019 – Third Party Liability in Medicaid and CHIP

HPA 21-02: Developmental Screening, Autism Screening, and Perinatal Depression Screenings

HPA 21-01: Donor Human Milk

HPA 20-25: EPSDT Periodicity Schedule

HPA 20-24: MCO Preparation – 2021 Healthcare Common Procedure Coding System Update

HPA 20-23 ESRD Facilities and Independent Laboratory – Non-Routine Laboratory Services (Revised November 30, 2020)

HPA 20-22: Inpatient Concurrent Care

HPA 20-21: Obstetric Ultrasounds by Maternal Fetal Medicine Specialists

HPA 20-20 Dental Benefit Program Manager Update

HPA 20-19 Changes to Durable Medical Equipment, Pediatric Day Health Care, Home Health, Rehabilitation and Personal Care Services due to Hurricane Delta

HPA 20-18 Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Personal Care Services (PCS) Update for Hurricane Laura

HPA 20-17 Changes to Durable Medical Equipment, Pediatric Day Health Care, Home Health, Rehabilitation and Personal Care Services due to Hurricane Laura (Revised September 1, 2020)

HPA 20-16 Class Action Lawsuit: AJ v. LDH

HPA 20-15 Long-Term Electroencephalography (EEG) Setup and Monitoring 

HPA 20-14 Tobacco Cessation for Pregnant Women (Revised October 14, 2020)

HPA 20-13 COVID-19 Update for PDHC Facilities

HPA 20-12 Telehealth Marketing and Member Education

HPA 20-11 Revised 96-A Hysterectomy Acknowledgment Form

HPA 20-10 EPSDT Personal Care Services

HPA 20-9 COVID-19 – SUD Telemedicine/Telehealth (Revised February 25, 2021)

HPA 20-8 COVID-19 – LMHP Telemedicine/Telehealth (Revised February 25, 2021)

HPA 20-7 COVID-19 – MHR Telemedicine/Telehealth (Revised February 25, 2021)

HPA 20-6 Response to COVID-19 (Revised March 26, 2021)

HPA 20-5 PASRR Level II Evaluations: COVID-19 (Revised April 13, 2020)

HPA 20-4 2020 HCPCS and Physician-Administered Drug Reimbursement Updates

HPA 20-3 Reimbursement of Opioid Use Disorder Treatment in Opioid Treatment Programs (Revised August 12, 2020)

HPA 20-2 Telemedicine and Telehealth Billing Changes for RHCs and FQHCs

HPA 20-1 LSU Enhanced Professional Service Fees to be Paid Effective 1/1/2020 (Revised February 26, 2020)

HPA 19-18 2020 Healthcare Common Procedure Coding System (HCPCS) Update

HPA 19-17 LPC and LMFT Reimbursement in FQHCs and RHCs

HPA 19-16 Hospice Fee Schedule Federal Fiscal Year 2020

HPA 19-15 Electronic Visit Verification for EPSDT Personal Care Services

HPA 19-14 Severe Combined Immunodeficiency (SCID) Testing

HPA 19-13 EPSDT PCS Rate Change

HPA 19-12 Changes to Durable Medical Equipment, Home Health, Rehabilitation and Personal Care Services and Pharmacy Due to Tropical Storm Barry (Revised August 7, 2019)

HPA 19-11 Telemedicine/Telehealth Billing Changes

HPA 19-10 Definitive Drug Testing (Revised July 19, 2019)

HPA 19-9 CLIA Number Information (Revised January 3, 2020)

HPA 19-8 Extended Home Health TV Modifier Use

HPA 19-7 Behavioral Health Alternate Payment Methodology in FQHCs and RHCs

HPA 19-6 Applied Behavior Analysis Fee Schedule

HPA 19-5 Member Reassignment Policy Core Elements

HPA 19-4 Breast Pump Coverage – Attestation and Equipment Requirements

HPA 19-3 2019 HCPCS and Physician-Administered Drug Reimbursement Updates

HPA 19-2 Pharmacy Copay Threshold (Revised February 20, 2019)

HPA 19-1 2019 Healthcare Common Procedure Coding System (HCPCS) Update

HPA 18-25 New Medicaid Policy: Non-Invasive Prenatal Testing (Revised October 6, 2020)

HPA 18-24 Immunization Coverage Update – Hepatitis B Adult 2 Dose Vaccine 

HPA 18-23 Updated Codes for Applied Behavior Analysis (ABA) Services  

HPA 18-22 Preparation – 2019 Healthcare Common Procedure Coding System (HCPCS) Update

HPA 18-21 Preventive Medicine Visits for Women

HPA 18-20 Hospice Fee Schedule FFY19

HPA 18-19: Reimbursement for Lynch Syndrome and Familial Adenomatous Polyposis Genetic Testing

HPA 18-18: Reimbursement for Screening and Diagnostic Mammographies for FQHC and RHC Providers

HPA 18-17: Separate Reimbursement for Long-Acting Reversible Contraceptives in FQHCs and RHCs

HPA 18-16: Coverage of Electric Breast Pumps

HPA 18-15: Coverage of Continuous Glucose Monitoring Devices (Retired)

HPA 18-14: Physician Administered Drugs Reimbursement Changes

HPA 18-13: OPH – “Family Planning Clinic” Fee Schedule 

HPA 18-12: Emergency Contraceptives

HPA 18-11: Managed Care Linkage for Long Term Care Members (Revised August 3, 2018)

HPA 18-10: Physician Administered Drugs

HPA 18-9: Common Observation Policy

HPA 18-8: Portable Oxygen Coverage and Reimbursement

HPA 18-7: Rehabilitation Therapy Services (Revised February 6, 2019)

HPA 18-6: 2018 Louisiana Medicaid EPSDT Periodicity Schedule (Made obsolete by HPA 20-25)

HPA 18-5: Prior Authorization of Non-Emergency Ambulance Services (Revised April 26, 2018)

HPA 18-4: Ambulance Non-Covered Services Modifiers

HPA 18-3: Proton Beam Radiation Therapy -- Age Criteria Revised

HPA 18-2: 2018 HCPCS and Fee Schedule Updates

HPA 18-1: 2018 Healthcare Common Procedure Coding System (HCPCS) Update #2

HPA 17-23: Drug Utilization Review (DUR) Program (Revised August 6, 2020)

HPA 17-22: Neonatal/Pediatric Critical Care Billing

HPA 17-21: Clarification of Louisiana Medicaid Policy Regarding Pediatric Moderate Conscious Sedation

HPA 17-20: 2018 Healthcare Common Procedure Coding System (HCPCS) Update Preparation

HPA 17-19: Applied Behavior Analysis Services

HPA 17-18: Changes to Pharmacy Services due to Tropical Storm Nate (Retired effective Oct. 9, 2017 at 11:59 p.m.)

HPA 17-17: Changes to Durable Medical Equipment due to Tropical Storm Nate (Retired effective Oct. 9, 2017 at 11:59 p.m.)

HPA 17-16: Medical Transportation Requirements and Post-Authorization for Emergency Air Ambulance Transportation Services (Revised October 10, 2017)

 HPA 17-15: Guidance for Medicare Advantage Participation

HPA 17-14: Influenza Virus Vaccine (CPT Code 90686) Age Revision

HPA 17-13: Hospice Rates for Federal Fiscal Year 2017

HPA 17-12: TPL Scope of Coverage Response on MCO Provider Portals

HPA 17-11: Approval Guidelines for Lien Settlements Equal to or Greater than $25,000

HPA 17-10: Louisiana Medicaid Fee Schedule Update Change

HPA 17-9: Clinical Laboratory Services - Fee Reimbursement (Revised May 12, 2017)

HPA 17-8: Single PDL for Selected Therapeutic Classes (Revised September 1, 2017)

HPA 17-7: Updated Opioid Prescription Policy (Revised June 9, 2017)

HPA 17-6: Common Preferred Drug List (PDL)  (Revised June 2, 2017)

HPA 17-5: 2017 Healthcare Common Procedure Coding System (HCPCS) Update

HPA 17-4: 340B Policy - Claim Level Indicators (Revised September 18, 2020)

HPA 17-3: Errors in the NCCI Edit File - Physical and Occupational Therapy Codes

HPA 17-2: Errors in the NCCI Edit File - Moderation Sedation Codes

HPA 17-1: Post-Payment COB Recoveries from Providers and Liable Third Parties (Revised March 1, 2017)

HPA 16-38: Priority Payer Name for Pay and Chase Records (Revised March 17, 2017)

HPA 16-37: 2017 Healthcare Common Procedure Coding System (HCPCS) Update

HPA 16-36: VFC Coverage of Human Papilloma Virus (HPV) Vaccine, CPT Code 90651

HPA 16-35: Opioid Edits for Pharmacy Claims (Revised March 17, 2017)

HPA 16-34: Inpatient Billing after Outpatient Status

HPA 16-33: Papanicolaou Test (Pap Test) Age Criteria (Revised Jan. 26, 2017)

HPA 16-32: Billing Immunization Administration Code 90472

HPA 16-31: Retroactive Member Enrollment Claims Processing

HPA 16-30: Global Maternity Procedure Codes (Revised March 28, 2017)

HPA 16-29: Pharmacy copayment exemptions for preventive medications

HPA 16-28: Intranasal Flu Vaccines for 2016-2017

HPA 16-27: Managed Care Organization (MCO) Returned Mail Procedures

HPA 16-26: Preventive Services Added to Fee Schedule as a Result of Medicaid Expansion

HPA 16-25: New Breast Reconstruction Post Mastectomy Policy

HPA 16-24: New Genetic Testing for Breast and Ovarian Cancer (BRCA)

HPA 16-23: Crisis Stabilization-New State Plan Service

HPA 16-22: Managing Third Party Liability File Exchanges and Member Updates for Medicaid Enrollees

HPA 16-21: Functional Family Therapy - Child Welfare (FFT-CW) Service Expansion

HPA 16-20: Federally Qualified Health Centers Annual Rate Notification Process

HPA 16-19: Surgical and Maternity Anesthesia Policy

HPA 16-18: Local Pharmacy Claims Dispute Process (Revised March 27, 2018)

HPA 16-17: Pay and Chase (Revised April 1, 2021)

HPA 16-16: Early and Periodic Screening, Diagnosis and Treatment Personal Care Services Policy Clarification

HPA 16-15: Procedures for Assuring Compliance with Chisholm v Gee

HPA 16-14: Mosquito Repellent Coverage as a Pharmacy Benefit (Revised December 27, 2016)

HPA 16-13: Home Health Services: Transition to 15-Minute Units for Home Health Aide Services

HPA 16-12: Implementation of New Service Intensity Add-On Rates

HPA 16-11: Healthy Louisiana Rebranding

HPA 16-10: Pharmacy Provider Fee

HPA 16-9: Home Health Services: Transition to 15-Minute Units for Registered Nurse and Licensed Practical Nurse Services

HPA 16-8: Batch Pharmacy Encounters Companion Guide and Batch Pharmacy Encounter Processing Edits Update (Revised April 5, 2016)

 HPA 16-7: 2016 Assistant Surgeon and Assistant at Surgery Covered Procedures

HPA 16-6: Identification and Utilization of scope of coverage 27-Major Medical, No Maternity Benefits and scope of coverage 33-HMO, No Maternity Benefits in Third Party Liability (TPL) System and Claims Processing

HPA 16-5: 2016 HCPCS Update for Professional Services, Laboratory, Radiology, ASC and Outpatient Hospital Fee Schedules

HPA 16-4: New Hospice Rates Effective January 1, 2016 (Retired)

HPA 16-3: Home Health: 2016 Healthcare Common Procedure Coding System (HCPCS) Update

HPA 16-2: 2016 Durable Medical Equipment, Prosthetic, and Orthotics and Supplies (DMEPOS) Healthcare Common Procedure Coding System (HCPCS) Update

HPA 16-1: Medicaid Coverage for Freestanding Birthing Centers

HPA 15-28: Claims Processing Edits for Provider Taxonomy (Retired)

HPA 15-27: Clarification of Policy Related to Hospital Owned Clinics and Provider Based Billing

HPA 15-26: Hospice Rates for Federal Fiscal Year 2016

HPA 15-25: Sterilization Consent Form

HPA 15-24: Reimbursement Rate Change Related to HCPCS Code J3490-TH (17 Alpha-Hydroxyprogesterone Caproate) 

HPA 15-23: Implementation of Act 390 of the 2015 Regular Legislative Session

HPA 15-22: Managed Care Organization Marketing Guidance for Focus Groups

HPA 15-21: Timely Filing Update

HPA 15-20: Immunization Procedure Code and Fee Schedule Update

HPA 15-19: Coverage and Reimbursement Guidelines for Current Procedural Terminology (CPT) Code 81220

HPA 15-18: Early and Periodic Screening Diagnostic and Treatment-Personal Care Services

HPA 15-17: "In Lieu of" Behavioral Health Services (Revised Feb. 23, 2018)

HPA 15-16: Managed Care Organization Claims and Encounter Instructions for Retro Dis-enrolled Members (Revised May 28, 2015)

HPA 15-15: Medicaid Behavioral Health Benefits and Services

HPA 15-14: Obstetrics Policy Billing Changes (Made obsolete by HPA 16-30) 

HPA 15-13: Medicaid Coverage for Freestanding Birthing Centers

HPA 15-12: 2015 Healthcare Common Procedure Coding System (HCPCS) Update (Revised May 22, 2015)

HPA 15-11: Transition of Retroactive Reimbursement Functions (Revised Aug. 19, 2015)

HPA 15-10: Shared Plan Member Claims - Reimbursement of Vagus Nerve Stimulator (VNS)

HPA 15-9: Change to Fee Schedule for Rotary Wing Ambulance Services

HPA 15-8: Early Elective Deliveries Data Receipt and Use by Bayou Health Shared Savings Plans (UHC and CHS)

HPA 15-7: Medicaid Recipient Insurance Updates

HPA 15-6: Claims Payment Methodology for LaHIPP Recipients (Retired May 15, 2019)

HPA 15-5: NEMT - Meals and Lodging

HPA 15-4: Authorization and Payment of Observation Status (Retired)

HPA 15-3: Healthcare Common Procedure Coding System (HCPCS) Codes Payable to Podiatrists

HPA 15-2: Covered and Non-Covered Inpatient Hospital Days

HPA 15-1: Medicaid Tuberculosis (TB) Program

HPA 14-16: Member Admissions to Skilled Nursing Facilities (Retired)

HPA 14-15: Update to DME Enteral Nutrition Fee Schedule

HPA 14-14: Correction of Assistant Surgeon Fee for CPT Code 59514

HPA 14-13: Radiation Treatment Management: Billing Clarification

HPA 14-12: Administrative Corrections for Retro Enrolled Newborns and Excluded Populations

HPA 14-11: Coverage of Compression Garments and Related Items

HPA 14-10: Coverage of Oncotype DX, Breast Cancer Assay for the Determination of Breast Cancer Prognosis

HPA 14-9: Long Acting Reversible Contraceptives in Hospital Settings (Revised May 22, 2018)

HPA 14-8: Provisional Medicaid Program Approved

HPA 14-7: Inclusion of Hospice Care into Bayou Health Core Benefits and Services

HPA 14-6: Makena Coverage Effective May 1, 2014

HPA 14-5: DME: Standing Frame Criteria and Form

HPA 14-4: Billing TPL Claims for Shared Plans

HPA 14-3: Rehabilitation Therapy-Reimbursement Methodology Change

HPA 14-2: 2014 Healthcare Common Procedure Coding System (HCPCS) Update

HPA 14-1: National Correct Coding Initiative Update

HPA 13-19: LTSS Provider Recruitment

HPA 13-18: Allergy Testing Update

HPA 13-17: Rate Changes

HPA 13-16: FQHC and RHC Crossover and Third Party Billing

HPA 13-15: Medicaid Eligibility Based on SSI

HPA 13-14: Crossover Code Indicator

HPA 13-13: Certificate of Creditable Coverage

HPA 13-12: Wearable Cardioverter Defibrillator (WCD) as a Covered Service

HPA 13-11: Individual Physical Therapists

HPA 13-10: Hospital DSMT Policy Update

HPA 13-9: Continuation of Benefits

HPA 13-8: Speech Therapy Services Update

HPA 13-7: Prior Authorization of HIV-AIDS Drugs

HPA 13-6: Skilled Nursing Facility Encounter Claims

HPA 13-5: Update Regarding Fees Related to New 2013 HCPCS Codes

HPA 13-4: Clarification of Authorization Representative

HPA 13-3: Marketing Guidance Under ACA Exchanges (Revised June 28, 2017)

HPA 13-2: Invalid Codes

HPA 13-1: Radiology Utilization Management Program

HPA 12-9: Provider Disputes (Revised February 27, 2019)

HPA 12-8: Sterilization Consent Form

HPA 12-7: Pediatric Day Health Care

HPA 12-6: Breast Reconstructive Surgery

HPA 12-5: Fee Schedule Advisory

HPA 12-4: DCFS Staff Contacts

HPA 12-3: Abortion Policy

HPA 12-2: Check Hold Date

HPA 12-1: Oral Surgery


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