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, which provides guidance to Medicaid providers and managed care organizations, emergency rules, and requests LDH 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/.

In accordance with La. R.S. 46:460.51, et seq., prior to adopting, approving, amending, or implementing certain policies or procedures, LDH will publish the proposed policy or procedure for the purpose of soliciting public comments. For this purpose, a policy or procedure, as defined by the statute, 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.

The following table contains the LDH and managed care organization policies and procedures that are open for public comment. To provide feedback, please complete this form. Refer to the links below the table for archived postings and public comments.

To see the LDH and managed care organization Pharmacy and Medical Drug Policies, click here.

To see Dental Benefit Plan Manager Policies, click here.

Item Number Policy/Procedure Date Posted Public Comments Due By Status Document Links
2021-HBL-599 Temporomandibular Disorders 6/17/21 7/31/21 Pending Temporomandibular Disorders
2021-HBL-807 Male Circumcision  6/17/21 7/31/21 Pending Male Circumcision
2021-HBL-983 Professional Anesthesia  6/17/21 7/31/21 Pending Professional Anesthesia
2021-HBL-1041 Cranial Remodeling Bands and Helmets  6/17/21 7/31/21 Pending Cranial Remodeling Bands and Helmets
2021-HBL-1042 Ablative Techniques as a treatment for Barrett’s Esophagus  6/17/21 7/31/21 Pending Ablative Techniques as a treatment for Barrett’s Esophagus
2021-HBL-1043 Alcohol Septal Ablation for treatment of Hypertrophic Cardiomyopathy  6/17/21 7/31/21 Pending Alcohol Septal Ablation for treatment of Hypertrophic Cardiomyopathy
2021-HBL-1044 Intraoperative Neurophysiological Monitoring  6/17/21 7/31/21 Pending Intraoperative Neurophysiological Monitoring
2021-HBL-1040 Genetic Testing for PTEN Hematoma Tumor Syndrome 6/14/21 7/28/21 Pending Genetic Testing for PTEN Hematoma Tumor Syndrome
2021-HBL-1039 BCR-ABLK Mutation Analysis 6/14/21 7/28/21 Pending BCR-ABLK Mutation Analysis
2021-HBL-1038 Enhanced External Counter pulsation in the outpatient setting 6/14/21 7/28/21 Pending Enhanced External Counter pulsation in the outpatient setting
2021-HBL-1037 Posterior Segment Optical Coherence Tomography 6/14/21 7/28/21 Pending Posterior Segment Optical Coherence Tomography
2021-HBL-1036 Home Health Utilization Management 6/14/21 7/28/21 Pending Home Health Utilization Management
2021-HBL-1035 Diaphragmatic/Phrenic Nerve stim and Diaph Pacing system 6/14/21 7/28/21 Pending Diaphragmatic/Phrenic Nerve stim and Diaph Pacing system
2021-HBL-1034 Anesthesia Services for Interventional Pain Management 6/14/21 7/28/21 Pending Anesthesia Services for Interventional Pain Management
2021-HBL-1033 Therapeutic Apheresis 6/14/21 7/28/21 Pending Therapeutic Apheresis
2021-HBL-1032 Transcath ablation of arrhyth foci in the pulm veins 6/14/21 7/28/21 Pending Transcath ablation of arrhyth foci in the pulm veins
2021-ACLA-1029 Endovascular treatment for intermittent claudication 6/14/21 7/28/21 Pending Endovascular treatment for intermittent claudication
2021-HBL-1028 Molecular (GIPP) Testing for Infectious Diarrhea in the outpatient setting 6/14/21 7/28/21 Pending Molecular (GIPP) Testing for Infectious Diarrhea in the outpatient setting
2021-HBL-1027 Red blood cell folic acid testing 6/14/21 7/28/21 Pending Red blood cell folic acid testing
2021-HBL-1026 Gene Expression Profiling for managing breast cancer treatment 6/14/21 7/28/21 Pending Gene Expression Profiling for managing breast cancer treatment
2021-HBL-1025 Detect and Quant of tumor DNA Usage next gen sequence in lymph cancers 6/14/21 7/28/21 Pending Detect and Quant of tumor DNA Usage next gen sequence in lymph cancers
2021-HBL-1024 Gene Mutat Test for solid tumor cancer susceptibility and management 6/14/21 7/28/21 Pending Gene Mutat Test for solid tumor cancer susceptibility and management
2021-HBL-1023 Genetic Testing for Inherited Disease 6/14/21 7/28/21 Pending Genetic Testing for Inherited Disease
2021-HBL-1022 Genotype Test for Individual Genetic Polymorph to determine Drug-metab status 6/14/21 7/28/21 Pending Genotype Test for Individual Genetic Polymorph to determine Drug-metab status
2021-HBL-1015 Mobile Devise-Based Health Management applications 6/14/21 7/28/21 Pending Mobile Devise-Based Health Management applications
2021-LHCC-994 Ambularoty Insulin Pump 6/14/21 7/28/21 Pending Ambularoty Insulin Pump
2021-HBL-810 Bone Mineral Density Testing Measurement 6/14/21 7/28/21 Pending Bone Mineral Density Testing Measurement
2021-HBL-809 Inpatient Inter-facility Transfers 6/14/21 7/28/21 Pending Inpatient Inter-facility Transfers
2021-HBL-805 Nininvasive Home Ventilator Therapy for Respiratory Failure 6/14/21 7/28/21 Pending Nininvasive Home Ventilator Therapy for Respiratory Failure
2021-HBL-801 Single Photon Emission CTS for Non-cardiovascular Indications 6/14/21 7/28/21 Pending Single Photon Emission CTS for Non-cardiovascular Indications
2021-HBL-597 Electric Tumor Treatment Field 6/14/21 7/28/21 Pending Electric Tumor Treatment Field
2021-HBL-590 Gene Expression Profiling for Coronary Artery Disease 6/14/21 7/28/21 Pending Gene Expression Profiling for Coronary Artery Disease
2021-LDH-6 Part 7: Provider Services > Enrollee Reassignment Policy 6/10/21 7/25/2021 Pending Part 7: Provider Services > Enrollee Reassignment Policy
2021-LHCC-912 Medical Management 6/10/21 7/25/21 Pending Medical Management - Attachment 1, Attachment 2, Attachment 3, Attachment 4, Attachment 5, Attachment 6, Attachment 7, Attachment 8, Attachment 9, Attachment 10
2021-HBL-999 UM AROW 1327 PA Requirements 6/8/21 7/23/21 Pending UM AROW 1327 PA Requirements
2021-HBL-1004 UM AROW 1837 PA Requirements 6/8/21 7/23/21 Pending UM AROW 1837 PA Requirements
2021-HBL-1005 UM AROW 1576 PA Requirements 6/8/21 7/23/21 Pending UM AROW 1576 PA Requirements
2021-HBL-1014 Imaging of the Chest (AIM) 6/7/21 7/22/21 Pending Imaging of the Chest (AIM)
2021-HBL-1013 Imaging of the Head and Neck (AIM) 6/7/21 7/22/21 Pending Imaging of the Head and Neck (AIM)
2021-HBL-1012 Oncology Imaging (AIM) 6/7/21 7/22/21 Pending Oncology Imaging (AIM)
2021-HBL-1011 Radiation Oncology (AIM) 6/7/21 7/22/21 Pending Radiation Oncology (AIM)
2021-HBL-1010 Imaging of the Brain (AIM) 6/7/21 7/22/21 Pending Imaging of the Brain (AIM)
2021-HBL-1009 Advanced Imaging of the Heart (AIM) 6/7/21 7/22/21 Pending Advanced Imaging of the Heart (AIM)
2021-HBL-985 Small Joint Surgery Criteria (AIM) 6/7/21 7/22/21 Pending Small Joint Surgery Criteria (AIM)
2021-UHC-961 Elective Inpatient Services 6/7/21 7/22/21 Pending Elective Inpatient Services
2021-HBL-256 Member Complaints and Grievances 6/7/21 7/22/21 Pending Member Complaints and Grievances
2021-LHCC-338 Perinatal Substance Use Disorder Care Management Program 5/27/21 7/11/21 Pending Perinatal Substance Use Disorder Care Management Program
2021-LHCC-911 Network Adequacy 5/27/21 7/11/21 Pending Network Adequacy
2021-HBL-951 Durable Medical Equipment 5/27/21 7/11/21 Pending Durable Medical Equipment
2021-ABH-953 Multi-Systemic Therapy (MST) 5/27/21 7/11/21 Pending Multi-Systemic Therapy (MST)
2021-ABH-954 Community Psychiatric Support and Treatment and Psychosocial Rehabilitation 5/27/21 7/11/21 Pending Community Psychiatric Support and Treatment and Psychosocial Rehabilitation
2021-ABH-955 Cris Intervention Services 5/27/21 7/11/21 Pending Cris Intervention Services
2021-ABH-956 Concurrent Review-Observation Care 5/27/21 7/11/21 Pending Concurrent Review-Observation Care
2021-ABH-957 Assertive Community Treatment Services 5/27/21 7/11/21 Pending Assertive Community Treatment Services
2021-ACLA-984 Behavioral Health Provider Quality Monitoring Plan 5/27/21 7/11/21 Pending Behavioral Health Provider Quality Monitoring Plan
2021-ACLA-989 Ambulance Services 5/27/21 7/11/21 Pending Ambulance Services
2021-LDH-5 Part 4: Services > Professional Services > Obstetrics 5/20/21 7/4/21 Pending MCO Manual: Obstetrics -- Tobacco Cessation
2021-HBL-986 Diagnostic Coronary Angiography 5/13/21 6/27/21 Pending Diagnostic Coronary Angiography
2021-HBL-998 Laser Trabeculoplasty and Laser Peripheral Iridotomy 5/13/21 6/27/21 Pending Laser Trabeculoplasty and Laser Peripheral Iridotomy
2021-LHCC-990 Medical Necessity
Review
5/13/21 6/27/21 Pending Medical Necessity
Review
2021-LHCC-991 Concurrent Review 5/13/21 6/27/21 Pending Concurrent Review
2021-LHCC-992 Post Discharge Member Outreach Calls 5/13/21 6/27/21 Pending Post Discharge Member Outreach Calls
2021-LHCC-993 Administrative Denials 5/13/21 6/27/21 Pending Administrative Denials
2021-LHCC-140

Timeliness of UM Decisions

5/13/21 6/27/21 Pending

Timeliness of UM Decisions

Attachment 1

Attachment 2

2021-LHCC-982

Outpatient Applied Behavioral Analysis Medical Necessity

5/13/21 6/27/21 Pending Outpatient Applied Behavioral Analysis Medical Necessity
2021-HBL-952

Multiple and Bilateral Policy

5/13/21 6/27/21 Pending Multiple and Bilateral Policy
2021-HBL-947

Modifier 90 Reimbursement Policy

5/13/21 6/27/21 Pending Modifier 90 Reimbursement Policy
2021-LHCC-915

PASRR Level II Evaluations Work Plan

5/13/21 6/27/21 Pending PASRR Level II Evaluations Work Plan
2021-LHCC-913

PASRR Level II Evaluations

5/13/21 6/27/21 Pending PASRR Level II Evaluations
2021-LHCC-606

Grievance Process

5/13/21 6/27/21 Pending Grievance Process
2021-LHCC-504

Quality PIPs

5/13/21 6/27/21 Pending Quality PIPs
2021-LHCC-501

Access to Non-Emergency Transportation

5/13/21 6/27/21 Pending Access to Non-Emergency Transportation

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