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-ABH-1135 Drug Biological Policy 10/12/21 11/27/21 Pending Drug Biological Policy
2021-ACLA-1148 Unlisted Studies 10/12/21 11/26/21 Pending Unlisted Studies
2021-ACLA-1147 Brain PET Scan 10/12/21 11/26/21 Pending Brain PET Scan
2021-HBL-1145 Neuromuscular Stimulation in the Treatment of Muscle Atrophy 10/12/21 11/26/21 Pending Neuromuscular Stimulation in the Treatment of Muscle Atrophy
2021-ACLA-893 Abdomen CT Angiography 10/12/21 11/26/21 Pending Abdomen CT Angiography
2021-ACLA-892 Abdomen CT 10/12/21 11/26/21 Pending Abdomen CT
2021-ACLA-891 Abdomen MRI, MRCP 10/12/21 11/26/21 Pending Abdomen MRI, MRCP
2021-ACLA-890 Abdomen/Pelvis CT Combo 10/12/21 11/26/21 Pending Abdomen/Pelvis CT Combo
2021-ACLA-889 Abdomen MRA (Angiography) 10/12/21 11/26/21 Pending Abdomen MRA (Angiography)
2021-ACLA-888 Abdomen/Pelvis CT Combo 10/12/21 11/26/21 Pending Abdomen/Pelvis CT Combo
2021-ACLA-887 Abdominal Arteries CT Angiography 10/12/21 11/26/21 Pending Abdominal Arteries CT Angiography
2021-ACLA-886 Bone Marrow MRI 10/12/21 11/26/21 Pending Bone Marrow MRI
2021-ACLA-885 Brain (Head) CTA 10/12/21 11/26/21 Pending Brain (Head) CTA
2021-ACLA-884 Brain (Head) MRA/MRV 10/12/21 11/26/21 Pending Brain (Head) MRA/MRV
2021-ACLA-883 Brain (Head) CT 10/12/21 11/26/21 Pending Brain (Head) CT
2021-ACLA-882 Brain (Head) MRI, Brain (Head) MRI with IAC (Internal Auditory Canal) 10/12/21 11/26/21 Pending Brain (Head) MRI, Brain (Head) MRI with IAC (Internal Auditory Canal)
2021-ACLA-881 Cervical Spine CT 10/12/21 11/26/21 Pending Cervical Spine CT
2021-ACLA-880 Cervical Spine MRI 10/12/21 11/26/21 Pending Cervical Spine MRI
2021-ACLA-879 Brain (Head) MRS 10/12/21 11/26/21 Pending Brain (Head) MRS
2021-ACLA-878 Chest (Thorax) MRI 10/12/21 11/26/21 Pending Chest (Thorax) MRI
2021-ACLA-877 Chest MRA 10/12/21 11/26/21 Pending Chest MRA
2021-ACLA-876 Chest CTA 10/12/21 11/26/21 Pending Chest CTA
2021-ACLA-875 Chest (Thorax) CT 10/12/21 11/26/21 Pending Chest (Thorax) CT
2021-ACLA-874 CT Virtual Colonoscopy 10/12/21 11/26/21 Pending CT Virtual Colonoscopy
2021-ACLA-873 CT Bone Density Study 10/12/21 11/26/21 Pending CT Bone Density Study
2021-ACLA-872 CT Coronary Angiography (CCTA) 10/12/21 11/26/21 Pending CT Coronary Angiography (CCTA)
2021-ACLA-871 Sinus Face Orbit MRI 10/12/21 11/26/21 Pending Sinus Face Orbit MRI
2021-ACLA-870 Temporal Bone, Mastoid, Orbits, Sella, Internal Auditory Canal MRI 10/12/21 11/26/21 Pending Temporal Bone, Mastoid, Orbits, Sella, Internal Auditory Canal MRI
2021-ACLA-869 Sinus & Maxillofacial CT 10/12/21 11/26/21 Pending Sinus & Maxillofacial CT
2021-ACLA-868 Spinal Canal MRA 10/12/21 11/26/21 Pending Spinal Canal MRA
2021-ACLA-867 Temporomandibular Joint (TMJ) MRI 10/12/21 11/26/21 Pending Temporomandibular Joint (TMJ) MRI
2021-ACLA-866 Thoracic Spine CT 10/12/21 11/26/21 Pending Thoracic Spine CT
2021-ACLA-865 Upper Extremity CTA/CTV 10/12/21 11/26/21 Pending Upper Extremity CTA/CTV
2021-ACLA-864 Lower Extremity CTA/CTV 10/12/21 11/26/21 Pending Lower Extremity CTA/CTV
2021-ACLA-863  Thoracic Spine MRI  10/12/21 11/26/21 Pending Thoracic Spine MRI 
2021-ACLA-862 Upper Extremity CTA/CTV 10/12/21 11/26/21 Pending Upper Extremity CTA/CTV
2021-ACLA-861 Breast MRI 10/12/21 11/26/21 Pending Breast MRI
2021-ACLA-859 Upper Extremity MRI 10/12/21 11/26/21 Pending Upper Extremity MRI
2021-ACLA-858 Upper Extremity MRA/MRV 10/12/21 11/26/21 Pending Upper Extremity MRA/MRV
2021-ACLA-857 CT Heart, CT Heart Congenital 10/12/21 11/26/21 Pending CT Heart, CT Heart Congenital
2021-ACLA-856 Functional Brain MRI 10/12/21 11/26/21 Pending Functional Brain MRI
2021-ACLA-855 Heart (cardiac) PET 10/12/21 11/26/21 Pending Heart (cardiac) PET
2021-ACLA-854 EBCT 10/12/21 11/26/21 Pending EBCT
2021-ACLA-853 Heart MRI 10/12/21 11/26/21 Pending Heart MRI
2021-ACLA-852 Heart (Cardiac) PET withy CT for Attenuation 10/12/21 11/26/21 Pending Heart (Cardiac) PET withy CT for Attenuation
2021-ACLA-851 Low Dose CT for Lung Cancer Screening 10/12/21 11/26/21 Pending Low Dose CT for Lung Cancer Screening
2021-ACLA-850 Lower Extremity CT 10/12/21 11/26/21 Pending Lower Extremity CT
2021-ACLA-849 Lower Extremity MRA/MRV 10/12/21 11/26/21 Pending Lower Extremity MRA/MRV
2021-ACLA-848 Lower Extremity MRI   10/12/21 11/26/21 Pending Lower Extremity MRI  
2021-ACLA-847

Lumbar Spine MRI

10/12/21 11/26/21 Pending Lumbar Spine MRI
2021-ACLA-846

Lumbar Spine CT

10/12/21 11/26/21 Pending Lumbar Spine CT
2021-ACLA-845

MPI Myocardial Perfusion Imaging

10/12/21 11/26/21 Pending MPI Myocardial Perfusion Imaging
2021-ACLA-844

Low Field MRI

10/12/21 11/26/21 Pending Low Field MRI
2021-ACLA-843

Neck CT

10/12/21 11/26/21 Pending Neck CT
2021-ACLA-842

MUGA Multiple Gated Acquisition Scan

10/12/21 11/26/21 Pending MUGA Multiple Gated Acquisition Scan
2021-ACLA-841

Neck CTA

10/12/21 11/26/21 Pending Neck CTA
2021-ACLA-840

Neck MRA/MRV

10/12/21 11/26/21 Pending Neck MRA/MRV
2021-ACLA-839

Pelvis CT

10/12/21 11/26/21 Pending Pelvis CT
2021-ACLA-838

Pelvis CT Angiography

10/12/21 11/26/21 Pending Pelvis CT Angiography
2021-ACLA-837

Pelvis MRA

10/12/21 11/26/21 Pending Pelvis MRA
2021-ACLA-836

Pelvis MRI

10/12/21 11/26/21 Pending Pelvis MRI
2021-ABH-1129

Home Health Home Infusion

10/11/21 11/25/21 Pending Home Health Home Infusion
2021-LDH-12

MCO Manual > Part 4: Services > Medical Transportation > Ambulance

(Proposed effective date = 12/27/2021)
10/7/21 11/21/21 Pending MCO Manual > Part 4: Services > Medical Transportation > Ambulance (Proposed effective date = 12/27/2021)
2021-HBL-1092 Cryoneurolysis for Treatment of Peripheral Nerve Pain 10/1/21 11/15/21 Pending Cryoneurolysis for Treatment of Peripheral Nerve Pain
2021-HBL-1116 Pre-Certification of Requested Services 10/1/21  11/15/21 Pending Pre-Certification of Requested Services
2021-ABH-1131 Revenue Code-HCPCS Code Links 10/1/21  11/15/21 Pending Revenue Code-HCPCS Code Links
2021-HBL-1146 Oral, Pharyn and Maxillo Surg Tx for Obstructive Sleep Apnea or Snoring 10/1/21  11/15/21 Pending Oral, Pharyn and Maxillo Surg Tx for Obstructive Sleep Apnea or Snoring
2021-HBL-1144 Vacuum Assisted Wound Therapy in the outpatient setting 9/24/21 11/8/21 Pending Vacuum Assisted Wound Therapy in the outpatient setting
2021-HBL-1143 Machie Learn der prob for rapid Kidney 9/24/21 11/8/21 Pending Machie Learn der prob for rapid Kidney
2021-HBL-1142 Perirectal Spacers for Use During Prostate Radiotherapy 9/24/21 11/8/21 Pending Perirectal Spacers for Use During Prostate Radiotherapy
2021-ABH-1126 Non-OB Ultrasound Redundant Policy 9/24/21 11/8/21 Pending Non-OB Ultrasound Redundant Policy
2021-HBL-543 Screening and Assessment for Autism Spectrum Disorders and Rett Syndrome 9/22/21 11/6/21 Pending Screening and Assessment for Autism Spectrum Disorders and Rett Syndrome
2021-HBL-598 Janus Kinase 2 CALR and MPL GENE Mutation Assays 9/22/21 11/6/21 Pending Janus Kinase 2 CALR and MPL GENE Mutation Assays
2021-HBL-600 Tonsillectomy for Children with or without Adenoidectomy 9/22/21 11/6/21 Pending Tonsillectomy for Children with or without Adenoidectomy
2021-HBL-1140 Prostate Biopsy using MRI Fusion Techniques 9/22/21 11/6/21 Pending Prostate Biopsy using MRI Fusion Techniques
2021-HBL-1141

Paired DNA and Messenger RNA (mRNA) Genetic Test to Detect, Diag Mng Cancer

9/22/21 11/6/21 Pending

Paired DNA and Messenger RNA (mRNA) Genetic Test to Detect, Diag Mng Cancer

2021-LDH-11

Part 4: Services > Professional Services > Skin Substitutes

9/22/21 11/6/21 Pending MCO Manual: Skin Substitutes
2021-LDH-10

Part 4: Services > Medical Transportation (NEMT)

9/14/21 10/29/21 Pending Medical Transportation: NEMT

RELATED INFO