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-HPA-3 HPA: Tobacco Cessation for Pregnant Women 8/11/20 9/25/20 Pending HPA: Tobacco Cessation for Pregnant Women
2020-IB-2 IB: Tobacco Cessation for Pregnant Women 8/11/20 9/25/20 Pending IB: Tobacco Cessation for Pregnant Women
2020-UHC-812 Vitamin D Policy 8/7/20 9/21/20 Pending Vitamin D Policy
2020-SCG-3 Tracking of Evidence Based Practices (EBP) 8/6/20 9/20/20 Pending MCO SCG July 2020 pg. 16-17
2020-PHARM-78  Asthma COPD Bronchodilator Anticholinergics Inhalation  7/31/20  9/14/20  Pending  Asthma COPD Bronchodilator Anticholinergics Inhalation 
2020-PHARM-77  Cytokineand CAM Antagonists  7/31/20   9/14/20  Pending  Cytokineand CAM Antagonists 
2020-PHARM-76  Dermatology Atopic Dermatitis Immunomodulators  7/31/20   9/14/20  Pending  Dermatology Atopic Dermatitis Immunomodulators  
2020-PHARM-75  Diabetes Hypoglycemics Incretin Mimetics Enhancers  7/31/20   9/14/20  Pending  Diabetes Hypoglycemics Incretin Mimetics Enhancers  
2020-PHARM-74  Esbriet  7/31/20   9/14/20  Pending  Esbriet
2020-PHARM-73  Fetroja  7/31/20   9/14/20   Pending Fetroja 
2020-PHARM-72  Givlaari  7/31/20   9/14/20  Pending  Givlaari 
2020-PHARM-71  Hepatitis C DAA  7/31/20   9/14/20  Pending  Hepatitis C DAA 
2020-PHARM-70  Infectious Disorders Hepatitis C Agents Direct Acting Antiviral Agents  7/31/20   9/14/20   Pending Infectious Disorders Hepatitis C Agents Direct Acting Antiviral Agents 
2020-PHARM-69 Koselugo   7/31/20   9/14/20  Pending  Koselugo 
2020-PHARM-68 Ofev  7/31/20   9/14/20  Pending  Ofev 
2020-PHARM-67 Oxbryta  7/31/20   9/14/20  Pending  Oxbryta 
2020-PHARM-66 POS DUR October 2020  7/31/20   9/14/20  Pending  POS DUR October 2020  
2020-PHARM-65 Sedative Hypnotics  7/31/20   9/14/20  Pending  Sedative Hypnotics  
2020-PHARM-64 Tikosyn  7/31/20   9/14/20  Pending  Tikosyn 
2020-PHARM-63 VMAT2 Inhibitors 7/31/20   9/14/20  Pending  VMAT2 Inhibitors 
2020-PHARM-62 Xenleta  7/31/20   9/14/20  Pending  Xenleta 
2020-HBL-366

Out-of-Area, Out-of-Network Care

7/24/20  9/7/20  Pending 

Out-of-Area, Out-of-Network Care

2020-HBL-542.1

2020-HBL-542.2

Anesthesia Services for Interventional Pain Management Procedures and Clinical Guidelines

7/24/20  9/7/20  Pending 

Anesthesia Services for Interventional Pain Management Procedures

Clinical Guidelines

2020-UHC-564

Benlysta

7/24/20  9/7/20  Pending 

Benlysta

2020-UHC-565

Crysvita

7/24/20  9/7/20  Pending 

Crysvita

2020-UHC-567

Maximum Dosage

7/24/20  9/7/20  Pending 

Maximum Dosage

2020-UHC-568 Ocrevus 7/24/20  9/7/20  Pending Ocrevus
2020-UHC-569 Off Label Unproven  7/24/20  9/7/20  Pending  Off Label Unproven
2020-UHC-572 Reblozyl  7/24/20  9/7/20  Pending Reblozyl
2020-UHC-574 Testosterone Replacement  7/24/20  9/7/20  Pending  Testosterone Replacement
2020-LHCC-610 Authorization Error Correction Process  7/24/20  9/7/20  Pending  Authorization Error Correction Process
2020-LHCC-636 Authorization for Second Clinical Opinions  7/24/20  9/7/20  Pending  Authorization for Second Clinical Opinions 
2020-LHCC-682 Active Procedures in Physical Medicine  7/24/20  9/7/20  Pending  Active Procedures in Physical Medicine
2020-LHCC-683 Chiro Infant Care Policy  7/24/20  9/7/20  Pending Chiro Infant Care Policy
2020-LHCC-684 Chiro Infant Care Policy  7/24/20  9/7/20  Pending  Chiro Infant Care Policy
2020-LHCC-685 Experimental, Unproven, or Investigational Services  7/24/20  9/7/20  Pending  Experimental, Unproven, or Investigational Services
2020-HB-PHARM-1

Louisiana Compound Coverage

7/21/20 9/4/20 Pending

Louisiana Compound Coverage

2020-HBL-318

Clinical Information for Utilization Review

7/16/20 8/30/20 Pending

Clinical Information for Utilization Review

2020-HBL-328 Pre-Certification of Requested Services 7/16/20 8/30/20 Pending Pre-Certification of Requested Services
2020-UHC-535

Nat'l Drug Code (NDC) Requirement Policy

7/16/20 8/30/20 Pending Nat'l Drug Code (NDC) Requirement Policy
2020-ACLA-538 PCP Assignment 7/16/20 8/30/20 Pending PCP Assignment
2020-HBL-588 Retrospective Review 7/16/20 8/30/20 Pending Retrospective Review
2020-LHCC-609 Court Ordered Services Louisiana PP   7/16/20 8/30/20 Pending Court Ordered Services Louisiana PP  
2020-HBL-677 SPOT AIM Rehab Transition Bulletin 7/16/20 8/30/20 Pending SPOT AIM Rehab Transition Bulletin
2020-HBL-316 Associates Performing Utilization Review 7/9/20 8/23/20 Pending Associates Performing Utilization Review
2020-HBL-576 AIM Musculoskeletal Prog Clinical Appropriateness Guidelines 7/9/20 8/23/20 Pending AIM Musculoskeletal Prog Clinical Appropriateness Guidelines
2020-LHCC-329 Adverse Determinations 7/9/20 8/23/20 Pending Adverse Determinations
2020-LHCC-429 UM Program Description  7/9/20 8/23/20 Pending UM Program Description 
2020-LHCC-498 Mental Health Rehab MNC Policy 7/9/20 8/23/20 Pending Mental Health Rehab MNC Policy
2020-LHCC-532

Appropriate UM Professionals

7/9/20 8/23/20 Pending

Appropriate UM Professionals

2020-LHCC-607 Inpatient Leveling of Care WP 7/9/20 8/23/20 Pending Inpatient Leveling of Care WP
2020-UHC-557 Transcranial Magnetic Stimulation 7/9/20 8/23/20 Pending Transcranial Magnetic Stimulation
2020-UHC-558

Knee Replacement Surgery (Arthroplasty), Total and Partial

7/9/20 8/23/20 Pending

Knee Replacement Surgery (Arthroplasty), Total and Partial

2020-UHC-559 Implantable Beta-Emitting Microspheres 7/9/20 8/23/20 Pending Implantable Beta-Emitting Microspheres
2020-UHC-560 Home Hemodialysis 7/9/20 8/23/20 Pending Home Hemodialysis
2020-UHC-561 Cognitive Rehabilitation 7/9/20 8/23/20 Pending Cognitive Rehabilitation
2020-HBL-602.1 Medical drug Clinical Criteria updates 7/2/20 8/16/20 Pending Medical drug Clinical Criteria updates
2020-HBL-602.2 Faslodex Criteria 7/2/20 8/16/20 Pending Faslodex Criteria
2020-HBL-602.3 Gazyva Criteria 7/2/20 8/16/20 Pending Gazyva Criteria
2020-HBL-602.4 Immunoglobulins Criteria 7/2/20 8/16/20 Pending Immunoglobulins Criteria
2020-HBL-602.5 Intravitreal Corticosteroid Implants Criteria 7/2/20 8/16/20 Pending Intravitreal Corticosteroid Implants Criteria
2020-HBL-602.6 Keytruda Criteria 7/2/20 8/16/20 Pending Keytruda Criteria
2020-HBL-602.7 Gonadotropin Releasing Hormone Analogs for the Treatment of Non-Oncologic Indications Criteria 7/2/20 8/16/20 Pending Gonadotropin Releasing Hormone Analogs for the Treatment of Non-Oncologic Indications Criteria
2020-LHCC-505 New Follow-Up After Hospitalization Policy 7/2/20 8/16/20 Pending New Follow-Up After Hospitalization Policy
2020-LHCC-611 Appeals Process 7/2/20 8/16/20 Pending Appeals Process
2020-UHC-563 Actemra Criteria 7/2/20 8/16/20 Pending Actemra Criteria
2020-UHC-570 Orencia Criteria 7/2/20 8/16/20 Pending Orencia Criteria
2020-LHCC-331   Provider Manual 6/25/20 8/10/20 Pending Provider Manual
2020-UHC-585  Chelation Therapy 6/25/20 8/10/20 Pending Chelation Therapy
2020-PHARM-61 Hepatitis C DAA 6/22/20 8/7/20 Pending Hepatitis C DAA

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