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 |
|
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 | |||
| 2021-LHCC-831 |
Act 421 Children’s Medicaid Option Policy |
3/16/21 | 4/29/21 | Pending | |||
| 2021-UHC-945 |
Act 421 LaHipp Notice |
3/16/21 | 4/29/21 | Pending | |||
| 2021-ABH-822 |
ABH Provider Manual |
3/10/21 | 4/23/21 | Pending | |||
| 2021-ACLA-944 |
Assertive Community Treatment |
3/10/21 | 4/23/21 | Pending | |||
| 2021-ABH-942 |
Urine Drug Testing Policy |
3/10/21 | 4/23/21 | Pending | |||
| 2021-ABH-939 |
Non-Invasive Prenatal Testing Policy |
3/10/21 | 4/23/21 | Pending | |||
| 2021-ABH-935 |
Obestrical Ultrasound Policy |
3/10/21 | 4/23/21 | Pending | |||
| 2021-ACLA-833 |
Act 421 Update |
3/10/21 | 4/23/21 | Pending | |||
| 2021-ACLA-893 |
Abdomen CT Angiography CG |
3/4/21 | 4/17/21 | Pending | |||
| 2021-ACLA-892 |
Abdomen CT CG |
3/4/21 | 4/17/21 | Pending | |||
| 2021-ACLA-891 |
Abdomen MRI, MRCP CG |
3/4/21 | 4/17/21 | Pending | |||
| 2021-ACLA-890 |
Abdomen/Pelvis CT Combo CG |
3/4/21 | 4/17/21 | Pending | |||
| 2021-ACLA-889 |
Abdomen MRA (Angiography) CG |
3/4/21 | 4/17/21 | Pending | |||
| 2021-ACLA-888 |
Abdomen/Pelvis CTA Combo CG |
3/4/21 | 4/17/21 | Pending | |||
| 2021-ACLA-887 |
Abdominal Arteries CT Angiography CG |
3/4/21 | 4/17/21 | Pending | |||
| 2021-ACLA-886 |
Bone Marrow MRI CG |
3/4/21 | 4/17/21 | Pending | |||
| 2021-ACLA-885 |
Brain (Head) CTA CG |
3/4/21 | 4/17/21 | Pending | |||
| 2021-ACLA-884 |
Brain (Head) MRA/MRV CG |
3/4/21 | 4/17/21 | Pending | |||
| 2021-ACLA-883 |
Brain (Head) CT CG |
3/4/21 | 4/17/21 | Pending | |||
| 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 | |||
| 2021-ACLA-880 |
Cervical Spine MRI CG |
3/3/21 | 4/16/21 | Pending | |||
| 2021-ACLA-879 |
Brain (Head) MRS CG |
3/3/21 | 4/16/21 | Pending | |||
| 2021-ACLA-878 |
Chest (Thorax) MRI CG |
3/3/21 | 4/16/21 | Pending | |||
| 2021-ACLA-877 |
Chest MRA CG |
3/3/21 | 4/16/21 | Pending | |||
| 2021-ACLA-876 |
Chest CTA CG |
3/3/21 | 4/16/21 | Pending | |||
| 2021-ACLA-875 |
Chest (Thorax) CT CG |
3/3/21 | 4/16/21 | Pending | |||
| 2021-ACLA-874 |
CT (Virtual) Colonoscopy CG |
3/3/21 | 4/16/21 | Pending | |||
| 2021-ACLA-873 |
CT Bone Density Study CG |
3/3/21 | 4/16/21 | Pending | |||
| 2021-ACLA-872 |
CT Coronary Angiography (CCTA) CG |
3/3/21 | 4/16/21 | Pending | |||
| 2021-ACLA-871 |
Sinus Face Orbit MRI CG |
3/3/21 | 4/16/21 | Pending | |||
| 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 | |||
| 2021-ACLA-867 |
Temporomandibular Joint (TMJ) MRI CG |
3/3/21 | 4/16/21 | Pending | |||
| 2021-ACLA-866 |
Thoracic Spine CT CG |
3/3/21 | 4/16/21 | Pending | |||
| 2021-ACLA-865 |
Upper Extremity CTA/CTV CG |
3/3/21 | 4/16/21 | Pending | |||
| 2021-ACLA-864 |
Lower Extremity CTA/CTV CG |
3/3/21 | 4/16/21 | Pending | |||
| 2021-ACLA-863 |
Thoracic Spine MRI CG |
3/3/21 | 4/16/21 | Pending | |||
| 2021-ACLA-862 |
Upper Extremity CT CG |
3/3/21 | 4/16/21 | Pending | |||
| 2021-ACLA-861 |
Breast MRI CG |
3/3/21 | 4/16/21 | Pending | |||
| 2021-ACLA-860 |
Ambulatory Surgery Center Procedures CG |
3/3/21 | 4/16/21 | Pending | |||
| 2021-ACLA-859 |
Upper Extremity MRI CG |
3/3/21 | 4/16/21 | Pending | |||
| 2021-ACLA-858 |
Upper Extremity MRA/MRV CG |
3/3/21 | 4/16/21 | Pending | |||
| 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 | |||
| 2021-ACLA-855 |
Heart (cardiac) PET |
3/2/21 | 4/15/21 | Pending | |||
| 2021-ACLA-854 |
Electron-Beam Tomography CG |
3/2/21 | 4/15/21 | Pending | |||
| 2021-ACLA-853 |
Heart MRI CG |
3/2/21 | 4/15/21 | Pending | |||
| 2021-ACLA-852 |
Heart (cardiac) PET with CT for Attenuation CG |
3/2/21 | 4/15/21 | Pending | |||
| 2021-ACLA-851 |
Low Dose CT for Lung Cancer Screening CG |
3/2/21 | 4/15/21 | Pending | |||
| 2021-ACLA-850 |
Lower Extremity CT CG |
3/2/21 | 4/15/21 | Pending | |||
| 2021-ACLA-849 |
Lower Extremity MRA/MRV CG |
3/2/21 | 4/15/21 | Pending | |||
| 2021-ACLA-848 |
Lower Extremity MRI (foot, ankle, knee, leg, or hip MRI) CG |
3/2/21 | 4/15/21 | Pending | |||
| 2021-ACLA-847 |
Lumbar Spine MRI CG |
3/2/21 | 4/15/21 | Pending | |||
| 2021-ACLA-846 |
Lumbar Spine CT CG |
3/2/21 | 4/15/21 | Pending | |||
| 2021-ACLA-845 |
Myocardial Perfusion Imaging CG |
3/2/21 | 4/15/21 | Pending | |||
| 2021-ACLA-843 |
Neck CT CG |
3/2/21 | 4/15/21 | Pending | |||
| 2021-ACLA-842 |
Multiple Gated Acquisition Scan CG |
3/2/21 | 4/15/21 | Pending | |||
| 2021-ACLA-841 |
Neck CTA CG |
3/2/21 | 4/15/21 | Pending | |||
| 2021-ACLA-840 |
Neck MRA/MRV CG |
3/2/21 | 4/15/21 | Pending | |||
| 2021-ACLA-839 |
Pelvis CT CG |
3/2/21 | 4/15/21 | Pending | |||
| 2021-ACLA-838 |
Pelvis CT Angiography CG |
3/2/21 | 4/15/21 | Pending | |||
| 2021-ACLA-837 |
Pelvis MRA CG |
3/2/21 | 4/15/21 | Pending | |||
| 2021-ACLA-836 |
Pelvis MRI CG |
3/2/21 | 4/15/21 | Pending | |||
| 2020-UHC-788 |
Mechanical Stretching Devices |
3/1/21 | 4/14/21 | Pending | |||
| 2020-UHC-785 |
Hearing Aids Devices |
3/1/21 | 4/14/21 | Pending | |||
| 2020-LHCC-681 |
Claims Payment Reporting and Auditing |
3/1/21 | 4/14/21 | Pending | |||
| 2020-LHCC-680 |
Provider Reimbursement |
3/1/21 | 4/14/21 | Pending | |||
| 2020-LHCC-635 |
COB TPL TB |
3/1/21 | 4/14/21 | Pending | |||
| 2020-HBL-586 |
Global Surgical Package Reimbursement |
3/1/21 | 4/14/21 | Pending | |||
| 2020-HBL-472 |
Women’s Health and Family Planning |
3/1/21 | 4/14/21 | Pending | |||
| 2021-LDH-2 |
|
2/24/21 | 4/10/21 | Pending | |||
| 2021-LDH-1 |
|
2/24/21 | 4/10/21 | Pending |
|
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