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 Comment Period Closed Status Document Links
2021-LDH-10

Part 4: Services > Professional Services > Medical Transportation (NEMT)

 9/14/21 10/29/21 Pending

Medical Transportation: NEMT
2021-UHC-1123

Extracorporeal Shock Wave Therapy (ESWT) for Musculoskeletal Conditions and Soft Tissue Wounds

 8/17/21 9/30/21 Pending

Extracorporeal Shock Wave Therapy (ESWT) for Musculoskeletal Conditions and Soft Tissue Wounds
2021-UHC-1122 Percutaneous Vertebroplasty and Kyphoplasty 8/17/21 9/30/21 Pending Percutaneous Vertebroplasty and Kyphoplasty
2021-UHC-1121 Intrauterine Fetal Surgery 8/17/21 9/30/21 Pending Intrauterine Fetal Surgery
2021-UHC-1120 Percutaneous Patent Foramen Ovale (PFO) Closure 8/17/21 9/30/21 Pending Percutaneous Patent Foramen Ovale (PFO) Closure
2021-UHC-1119 Bronchial Thermoplasty 8/17/21 9/30/21 Pending Bronchial Thermoplasty
2021-LHCC-1118 Preventive Health and Clinical Practice Guidelines 8/17/21 9/30/21 Pending Preventive Health and Clinical Practice Guidelines
2021-UHC-378 Surgery of the Shoulder 8/17/21 9/30/21 Pending Surgery of the Shoulder
2021-LHCC-1117 Contract Effective Date 8/13/21 9/26/21 Pending Contract Effective Date
2021-LDH-9 Part 4: Services > Professional Services > Early and Periodic Screening, Diagnostic, and Treatment Preventive Services Program 8/11/21 9/25/21 Pending EPSDT Preventive Services Program
2021-LDH-8 Part 4: Services > Professional Services > Physician Administered Medication 8/6/21 9/20/21 Pending Physician Administered Medication

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