Managed Care Policies & Procedures
COVID-19 Update: Changes to Medicaid policy and procedure deemed of an imminent peril to the public health, safety, or welfare and requiring immediate approval, such as those related to COVID-19, are exempt from the legislative requirement to publish the proposed policy or procedure for public comment prior to implementation. To keep abreast of these exempted changes to policy and procedure related to COVID-19, refer to the Coronavirus (COVID-19) Medicaid Information website. Here you will find guidance to Medicaid providers, guidance for MCOs via Health Plan Advisories, emergency rules and requests the Department has submitted to the Centers for Medicare & Medicaid Services (CMS). Broader information related to COVID-19 can be found at http://ldh.la.gov/Coronavirus/.
"Policy or procedure" shall mean a requirement governing the administration of managed care organizations specific to billing guidelines, medical management and utilization review guidelines, case management guidelines, claims processing guidelines and edits, grievance and appeals procedures and process, other guidelines or manuals containing pertinent information related to operations and pre-processing claims, and core benefits and services.
Below are the changes to the managed care policies and procedures beginning August 1, 2019. To provide feedback, please complete this form.
|Item Number||Policy/Procedure||Date Posted||Public Comments Due By||Status||Document Links|
|2020-ACLA-PHARM-4||Specialty Drugs PA Criteria||9/15/20||10/30/20||Pending||Specialty Drugs PA Criteria|
|2020-ACLA-PHARM-3||Oncology Drugs PA Criteria||9/8/20||10/24/20||Pending||Oncology Drugs PA Criteria|
|2020-ACLA-PHARM-2||Diabetic Testing Supplies||9/1/20||10/16/20||Pending||Diabetic Testing Supplies|
|2020-LHCC-817||Crisis Intervention Policy||8/28/20||10/12/20||Pending||Crisis Intervention Policy|
|2020-LHCC-817||Vitamin D Testing Policy||8/28/20||10/12/20||Pending||Vitamin D Testing Policy|
|2020-ABH-PHARM-1||Quantity Level Limit||8/19/20||10/3/20||Pending||Quantity Level Limit|
|2020-HBL-816||Vitamin D Policy||8/18/20||10/2/20||Pending||Vitamin D Policy|
|2020-ACLA-815||Vitamin D Policy||8/14/20||9/28/20||Pending||Vitamin D Policy|
|2020-ABH-813||Vitamin D Policy||8/14/20||9/28/20||Pending||Vitamin D Policy|