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-UHC-949

Chemotherapy – Observation or Inpatient Hospitalization

4/1/21 5/16/21 Pending Chemotherapy – Observation or Inpatient Hospitalization
2021-UHC-948

Catheter Ablation for Atrial Fibrilation

4/1/21 5/16/21 Pending Catheter Ablation for Atrial Fibrilation
2021-ABH-835

Vaccines for Children

3/31/21 5/15/21 Pending Vaccines for Children
2021-LHCC-927

Medical Record Review

3/18/21 5/2/21 Pending Medical Record Review
2021-LHCC-926

Provider Appointment Accessibility Standards

3/18/21 5/2/21 Pending Provider Appointment Accessibility Standards
2021-LHCC-925

Provider Complaints

3/18/21 5/2/21 Pending Provider Complaints
2021-LHCC-916

CM Assessment Process

3/18/21 5/2/21 Pending CM Assessment Process
2021-LHCC-830

Coordination of Benefits (COB/TPL) Act 421

3/18/21 5/2/21 Pending Coordination of Benefits (COB/TPL) Act 421
2021-LDH-4

LDH MCO Manual Part 11: Program Integrity

 3/17/21  5/1/21 Pending MCO Manual – Program Integrity
2021-LDH-3

LDH MCO Manual Part 4: Services > Professional Services > Obstetrics

3/17/21 5/1/21 Pending MCO Manual – Obstetrics
2021-ABH-937

Portable X-ray Policy

3/17/21 4/30/21 Pending

Portable X-ray Policy

2021-LHCC-831

Act 421 Children’s Medicaid Option Policy

3/16/21 4/29/21 Pending

Act 421 Children’s Medicaid Option Policy

2021-UHC-945

Act 421 LaHipp Notice

3/16/21 4/29/21 Pending

Act 421 LaHipp Notice

2021-ABH-822

ABH Provider Manual

3/10/21 4/23/21 Pending

ABH Provider Manual

2021-ACLA-944

Assertive Community Treatment

3/10/21 4/23/21 Pending

Assertive Community Treatment

2021-ABH-942

Urine Drug Testing Policy

3/10/21 4/23/21 Pending

Urine Drug Testing Policy

2021-ABH-939

Non-Invasive Prenatal Testing Policy

3/10/21 4/23/21 Pending

Non-Invasive Prenatal Testing Policy

2021-ABH-935

Obestrical Ultrasound Policy

3/10/21 4/23/21 Pending

Obestrical Ultrasound Policy

2021-ACLA-833

Act 421 Update

3/10/21 4/23/21 Pending

Act 421 Update

2021-ACLA-893

Abdomen CT Angiography CG

3/4/21 4/17/21 Pending

Abdomen CT Angiography CG

2021-ACLA-892

Abdomen CT CG

3/4/21 4/17/21 Pending

Abdomen CT CG

2021-ACLA-891

Abdomen MRI, MRCP CG

3/4/21 4/17/21 Pending

Abdomen MRI, MRCP CG

2021-ACLA-890

Abdomen/Pelvis CT Combo CG

3/4/21 4/17/21 Pending

Abdomen/Pelvis CT Combo CG

2021-ACLA-889

Abdomen MRA (Angiography) CG

3/4/21 4/17/21 Pending

Abdomen MRA (Angiography) CG

2021-ACLA-888

Abdomen/Pelvis CTA Combo CG

3/4/21 4/17/21 Pending

Abdomen/Pelvis CTA Combo CG

2021-ACLA-887

Abdominal Arteries CT Angiography CG

3/4/21 4/17/21 Pending

Abdominal Arteries CT Angiography CG

2021-ACLA-886

Bone Marrow MRI CG

3/4/21 4/17/21 Pending

Bone Marrow MRI CG

2021-ACLA-885

Brain (Head) CTA CG

3/4/21 4/17/21 Pending

Brain (Head) CTA CG

2021-ACLA-884

Brain (Head) MRA/MRV CG

3/4/21 4/17/21 Pending

Brain (Head) MRA/MRV CG

2021-ACLA-883

Brain (Head) CT CG

3/4/21 4/17/21 Pending

Brain (Head) CT CG

2021-ACLA-882

Brain (Head) MRI, Brain (Head) MRI with IAC (Internal Auditory Canal) CG

3/4/21 4/17/21 Pending

Brain (Head) MRI, Brain (Head) MRI with IAC (Internal Auditory Canal) CG

2021-ACLA-881

Cervical Spine CT CG

3/3/21 4/16/21 Pending

Cervical Spine CT CG

2021-ACLA-880

Cervical Spine MRI CG

3/3/21 4/16/21 Pending

Cervical Spine MRI CG

2021-ACLA-879

Brain (Head) MRS CG

3/3/21 4/16/21 Pending

Brain (Head) MRS CG

2021-ACLA-878

Chest (Thorax) MRI CG

3/3/21 4/16/21 Pending

Chest (Thorax) MRI CG

2021-ACLA-877

Chest MRA CG

3/3/21 4/16/21 Pending

Chest MRA CG

2021-ACLA-876

Chest CTA CG

3/3/21 4/16/21 Pending

Chest CTA CG

2021-ACLA-875

Chest (Thorax) CT CG

3/3/21 4/16/21 Pending

Chest (Thorax) CT CG

2021-ACLA-874

CT (Virtual) Colonoscopy CG

3/3/21 4/16/21 Pending

CT (Virtual) Colonoscopy CG

2021-ACLA-873

CT Bone Density Study CG

3/3/21 4/16/21 Pending

CT Bone Density Study CG

2021-ACLA-872

CT Coronary Angiography (CCTA) CG

3/3/21 4/16/21 Pending

CT Coronary Angiography (CCTA) CG

2021-ACLA-871

Sinus Face Orbit MRI CG

3/3/21 4/16/21 Pending

Sinus Face Orbit MRI CG

2021-ACLA-870

Temporal Bone, Mastoid, Orbits, Sella, Internal Auditory Canal CT CG

3/3/21 4/16/21 Pending

Temporal Bone, Mastoid, Orbits, Sella, Internal Auditory Canal CT CG

2021-ACLA-869

Sinus & Maxillofacial CT Limited or Localized Follow Up Sinus CT CG

3/3/21 4/16/21 Pending

Sinus & Maxillofacial CT Limited or Localized Follow Up Sinus CT CG

2021-ACLA-868

Spinal Canal MRA CG

3/3/21 4/16/21 Pending

Spinal Canal MRA CG

2021-ACLA-867

Temporomandibular Joint (TMJ) MRI CG

3/3/21 4/16/21 Pending

Temporomandibular Joint (TMJ) MRI CG

2021-ACLA-866

Thoracic Spine CT CG

3/3/21 4/16/21 Pending

Thoracic Spine CT CG

2021-ACLA-865

Upper Extremity CTA/CTV CG

3/3/21 4/16/21 Pending

Upper Extremity CTA/CTV CG

2021-ACLA-864

Lower Extremity CTA/CTV CG

3/3/21 4/16/21 Pending

Lower Extremity CTA/CTV CG

2021-ACLA-863

Thoracic Spine MRI CG

3/3/21 4/16/21 Pending

Thoracic Spine MRI CG

2021-ACLA-862

Upper Extremity CT CG

3/3/21 4/16/21 Pending

Upper Extremity CT CG

2021-ACLA-861

Breast MRI CG

3/3/21 4/16/21 Pending

Breast MRI CG

2021-ACLA-860

Ambulatory Surgery Center Procedures CG

3/3/21 4/16/21 Pending

Ambulatory Surgery Center Procedures CG

2021-ACLA-859

Upper Extremity MRI CG

3/3/21 4/16/21 Pending

Upper Extremity MRI CG

2021-ACLA-858

Upper Extremity MRA/MRV CG

3/3/21 4/16/21 Pending

Upper Extremity MRA/MRV CG

2021-ACLA-857

CT Heart, CT Heart Congenital (Not including coronary arteries) CG

3/3/21 4/16/21 Pending

CT Heart, CT Heart Congenital (Not including coronary arteries) CG

2021-ACLA-856

Functional Brain MRI

3/2/21  4/15/21 Pending

Functional Brain MRI

2021-ACLA-855

Heart (cardiac) PET

3/2/21 4/15/21 Pending

Heart (cardiac) PET

2021-ACLA-854

Electron-Beam Tomography CG

3/2/21 4/15/21 Pending

Electron-Beam Tomography CG

2021-ACLA-853

Heart MRI CG

3/2/21 4/15/21 Pending

Heart MRI CG

2021-ACLA-852

Heart (cardiac) PET with CT for Attenuation CG

3/2/21 4/15/21 Pending

Heart (cardiac) PET with CT for Attenuation CG

2021-ACLA-851

Low Dose CT for Lung Cancer Screening CG

3/2/21 4/15/21 Pending

Low Dose CT for Lung Cancer Screening CG

2021-ACLA-850

Lower Extremity CT CG

3/2/21 4/15/21 Pending

Lower Extremity CT CG

2021-ACLA-849

Lower Extremity MRA/MRV CG

3/2/21 4/15/21 Pending

Lower Extremity MRA/MRV CG

2021-ACLA-848

Lower Extremity MRI (foot, ankle, knee, leg, or hip MRI) CG

3/2/21 4/15/21 Pending

Lower Extremity MRI (foot, ankle, knee, leg, or hip MRI) CG

2021-ACLA-847

Lumbar Spine MRI CG

3/2/21 4/15/21 Pending

Lumbar Spine MRI CG

2021-ACLA-846

Lumbar Spine CT CG

3/2/21 4/15/21 Pending

Lumbar Spine CT CG

2021-ACLA-845

Myocardial Perfusion Imaging CG

3/2/21 4/15/21 Pending

Myocardial Perfusion Imaging CG

2021-ACLA-843

Neck CT CG

3/2/21 4/15/21 Pending

Neck CT CG

2021-ACLA-842

Multiple Gated Acquisition Scan CG

3/2/21 4/15/21 Pending

Multiple Gated Acquisition Scan CG

2021-ACLA-841

Neck CTA CG

3/2/21 4/15/21 Pending

Neck CTA CG

2021-ACLA-840

Neck MRA/MRV CG

3/2/21 4/15/21 Pending

Neck MRA/MRV CG

2021-ACLA-839

Pelvis CT CG

3/2/21 4/15/21 Pending

Pelvis CT CG

2021-ACLA-838

Pelvis CT Angiography CG

3/2/21 4/15/21 Pending

Pelvis CT Angiography CG

2021-ACLA-837

Pelvis MRA CG

3/2/21 4/15/21 Pending

Pelvis MRA CG

2021-ACLA-836

Pelvis MRI CG

3/2/21 4/15/21 Pending

Pelvis MRI CG

2020-UHC-788

Mechanical Stretching Devices

3/1/21 4/14/21 Pending

Mechanical Stretching Devices

2020-UHC-785

Hearing Aids Devices

3/1/21 4/14/21 Pending

Hearing Aids Devices

2020-LHCC-681

Claims Payment Reporting and Auditing

3/1/21 4/14/21 Pending

Claims Payment Reporting and Auditing

2020-LHCC-680

Provider Reimbursement

3/1/21 4/14/21 Pending

Provider Reimbursement

2020-LHCC-635

COB TPL TB

3/1/21 4/14/21 Pending

COB TPL TB

2020-HBL-586

Global Surgical Package Reimbursement

3/1/21 4/14/21 Pending

Global Surgical Package Reimbursement

2020-HBL-472

Women’s Health and Family Planning

3/1/21 4/14/21 Pending

Women’s Health and Family Planning

2021-LDH-2

LDH MCO Manual

Part 9: Third Party Liability

 2/24/21 4/10/21 Pending

LDH MCO Manual

Part 9: Third Party Liability

2021-LDH-1

LDH MCO Manual

Part 4: Services > Professional Services > "Incident to" Services

2/24/21 4/10/21 Pending

LDH MCO Manual

Part 4: Services > Professional Services > "Incident to" Services

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