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Medicaid Managed Care Policies & Procedures Archive (2024) Continued 2
"Policy or procedure" 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.
Below are items previously posted for public comment:
| Item Number | Policy/Procedure | Date Posted | Comment Period Closed | Status | Document Links |
|---|---|---|---|---|---|
| 2024-LHCC-1454 | Facet Joint Interventions | 8/7/24 | 9/21/24 | Approved | Facet Joint Interventions |
| 2024-LHCC-1456 | Fecal Incontinence Treatments | 8/7/24 | 9/21/24 | Approved | Fecal Incontinence Treatments |
| 2024-LHCC-1457 | Neuromuscular and Peroneal Nerve Electrical | 8/7/24 | 9/21/24 | Approved | Neuromuscular and Peroneal Nerve Electrical |
| 2024-LHCC-1746 | Total Artificial Heart | 8/7/24 | 9/21/24 | Approved | Total Artificial Heart |
| 2024-UHC-1815 | Cochlear Implants and Replacements | 8/7/24 | 9/21/24 | Approved | Cochlear Implants and Replacements |
| 2024-LHCC-1909 | Peer Support Services | 8/7/24 | 9/21/24 | Approved | Peer Support Services |
| 2024-LHCC-1917 | Repair of Nasal Valve Compromise | 8/7/24 | 9/21/24 | Approved | Repair of Nasal Valve Compromise |
| 2024-LHCC-1918 | Diabetes Self Management Training DSMT | 8/7/24 | 9/21/24 | Approved | Diabetes Self Management Training DSMT |
| 2024-LHCC-1933 | Personal Care Services PCS BH | 8/7/24 | 9/21/24 | Approved | Personal Care Services PCS BH |
| 2024-LHCC-2178 | Nicotinamide modified allogeneic | 8/7/24 | 9/21/24 | Approved | Nicotinamide modified allogeneic |
| 2024-UHC-2278 | EPSDT CM and SC Collaboration Policy LDH Medicaid Review | 8/7/24 | 9/21/24 | Approved | EPSDT CM and SC Collaboration Policy LDH Medicaid Review |
| 2024-ABH-2458 | Mandatory Birthweight Claim Inclusion | 8/7/24 | 9/21/24 | Approved | Mandatory Birthweight Claim Inclusion |
| 2024-HUM-2468 | Oxygen Probes | 8/7/24 | 9/21/24 | Approved | Oxygen Probes |
| 2024-HUM-2470 | EKG Service Limit | 8/7/24 | 9/21/24 | Approved | EKG Service Limit |
| 2024-ABH-2498 | Pediatric Day Health Care Louisiana | 8/7/24 | 9/21/24 | Approved | Pediatric Day Health Care Louisiana |
| 2024-UHC-2501 | Care Coordination with Medicaid | 8/7/24 | 9/21/24 | Approved | Care Coordination with Medicaid |
| 2024-HBL-2518 | Mechanical Circulatory Assist Devices | 8/7/24 | 9/21/24 | Approved | Mechanical Circulatory Assist Devices |
| 2024-LHCC-1108 | Pediatric Liver Transplant | 8/6/24 | 9/13/24 | Approved | Pediatric Liver Transplant |
| 2024-LHCC-1211 | Reduction Mammoplasty | 8/6/24 | 9/13/24 | Approved | Reduction Mammoplasty |
| 2024-LHCC-1213 | Sacroiliac Joint Fusion | 8/6/24 | 9/13/24 | Approved | Sacroiliac Joint Fusion |
| 2024-LHCC-1224 | Fetal Surgery in Utero for Prenatally | 8/6/24 | 9/13/24 | Approved | Fetal Surgery in Utero for Prenatally |
| 2024-HBL-1276 | ICD-10-CM Excludes1 notes | 8/6/24 | 9/13/24 | Approved | ICD-10-CM Excludes1 notes |
| 2024-LHCC-1357 | Intestinal and Multivisceral Transplant | 8/6/24 | 9/13/24 | Approved | Intestinal and Multivisceral Transplant |
| 2024-LHCC-1379 | Therapeutic Utilization of Inhaled Nitric Oxide | 8/6/24 | 9/13/24 | Approved | Therapeutic Utilization of Inhaled Nitric Oxide |
| 2024-LHCC-1380 | Multiple Sleep Latency Testing | 8/6/24 | 9/13/24 | Approved | Multiple Sleep Latency Testing |
| 2024-LHCC-1382 | Lysis of Epidural Lesions | 8/6/24 | 9/13/24 | Approved | Lysis of Epidural Lesions |
| 2024-LHCC-1383 | Disc Decompression Procedures | 8/6/24 | 9/13/24 | Approved | Disc Decompression Procedures |
| 2024-LHCC-1387 | Percutaneous Left Atrial Appendage | 8/6/24 | 9/13/24 | Approved | Percutaneous Left Atrial Appendage |
| 2024-LHCC-1412 | Clinical Trials | 8/6/24 | 9/13/24 | Approved | Clinical Trials |
| 2024-LHCC-1413 | Discography | 8/6/24 | 9/13/24 | Approved | Discography |
| 2024-LHCC-1452 | Caudal or Interlaminar Epidural Steroid Injections | 8/6/24 | 9/13/24 | Approved | Caudal or Interlaminar Epidural Steroid Injections |
| 2024-UHC-222 | skin soft tissue substitutes | 8/6/24 | 9/13/24 | Approved | skin soft tissue substitutes |
| 2024-UHC-476 | Cytological Examination of Breast Fluids for Cancer Screening or Diagnosis | 8/6/24 | 9/13/24 | Approved | Cytological Examination of Breast Fluids for Cancer Screening or Diagnosis |
| 2024-UHC-478 | Obstructive and Central Sleep Apnea Treatment | 8/6/24 | 9/13/24 | Approved | Obstructive and Central Sleep Apnea Treatment |
| 2024-UHC-562 | Sinus Procedures | 8/6/24 | 9/13/24 | Approved | Sinus Procedures |
| 2024-UHC-794 | Noncontact Warming Therapy, Ultrasound Therapy, and Fluorescence Imaging for Wounds | 8/6/24 | 9/13/24 | Approved | Noncontact Warming Therapy, Ultrasound Therapy, and Fluorescence Imaging for Wounds |
| 2024-ACLA-818 | Prior Authorization Service List Changes | 8/6/24 | 9/13/24 | Approved | Prior Authorization Service List Changes |
| 2024-HBL-1208 | Cosmetic and Reconstructive Services of the Trunk, Groin, and Extremities | 7/29/24 | 9/13/24 | Approved | Cosmetic and Reconstructive Services of the Trunk, Groin, and Extremities |
| 2024-HBL-1288 | Imaging of the Abdomen and Pelvis | 7/29/24 | 9/13/24 | Approved | Imaging of the Abdomen and Pelvis |
| 2024-HBL-1344 | Rehabilitative Devices with Remote Monitoring | 7/29/24 | 9/13/24 | Approved | Rehabilitative Devices with Remote Monitoring |
| 2024-UHC-1419 | Carrier Testing Panels for Genetic Diseases | 7/29/24 | 9/13/24 | Approved | Carrier Testing Panels for Genetic Diseases |
| 2024-LHCC-1479 | High Complexity Medical Decision-Making | 7/29/24 | 9/13/24 | Approved | High Complexity Medical Decision-Making |
| 2024-UHC-1797 | DOC Case Management Process Policy | 7/29/24 | 9/13/24 | Approved | DOC Case Management Process Policy |
| 2024-ACLA-1867 | Psychosocial rehabilitation services for children, adolescents, and adults |
7/29/24 | 9/13/24 | Approved | Psychosocial rehabilitation services for children, adolescents, and adults |
| 2024-UHC-2188 | Mandatory Medicaid Coverage of Routine Patient Costs in Qualifying Clinical Trials | 7/29/24 | 9/13/24 | Approved | Mandatory Medicaid Coverage of Routine Patient Costs in Qualifying Clinical Trials |
| 2024-LHCC-2229 | Concert Genetic Testing Dermatologic Conditions | 7/29/24 | 9/13/24 | Approved | Concert Genetic Testing Dermatologic Conditions |
| 2024-LHCC-2230 | Concert Genetic Testing Epilepsy Neurodegenerative | 7/29/24 | 9/13/24 | Approved | Concert Genetic Testing Epilepsy Neurodegenerative |
| 2024-LHCC-2237 | Concert Genetic Testing Hematologic Conditions Non Cancerous | 7/29/24 | 9/13/24 | Approved | Concert Genetic Testing Hematologic Conditions Non Cancerous |
| 2024-LHCC-2239 | Concert Genetics Oncology Cytogenetic Testing | 7/29/24 | 9/13/24 | Approved | Concert Genetics Oncology Cytogenetic Testing |
| 2024-LHCC-2243 | Concert Genetic Testing Non Invasive Prenatal Screening Nips | 7/29/24 | 9/13/24 | Approved | Concert Genetic Testing Non Invasive Prenatal Screening Nips |
| 2024-LHCC-2244 | Concert Genetic Testing Prenatal Diagnosis | 7/29/24 | 9/13/24 | Approved | Concert Genetic Testing Prenatal Diagnosis |
| 2024-LHCC-2246 | Concert Genetic Testing Metabolic Endocrine | 7/29/24 | 9/13/24 | Approved | Concert Genetic Testing Metabolic Endocrine |
| 2024-HBL-2288 | Prior authorization requirement changes effective | 7/29/24 | 9/13/24 | Approved | Prior authorization requirement changes effective |
| 2024-HBL-2326 | Hereditary Cancer Testing | 7/29/24 | 9/13/24 | Approved | Hereditary Cancer Testing |
| 2024-LHCC-2464 | Concert Genetics Genetic Testing Exome And Genome | 7/29/24 | 9/13/24 | Approved | Concert Genetics Genetic Testing Exome And Genome |
| 2024-HBL-2505 | Hematopoietic Stem Cell Transplantation for Pediatric Solid Tumors | 7/29/24 | 9/13/24 | Approved | Hematopoietic Stem Cell Transplantation for Pediatric Solid Tumors |
| 2024-HBL-2506 | Hematopoietic Stem Cell Transplantation for Autoimmune Disease and Miscellaneous Solid Tumors | 7/29/24 | 9/13/24 | Approved | Hematopoietic Stem Cell Transplantation for Autoimmune Disease and Miscellaneous Solid Tumors |
| 2024-HBL-2507 | Biomechanical Footwear Therapy | 7/29/24 | 9/13/24 | Approved | Biomechanical Footwear Therapy |
| 2024-HBL-2510 | Nanoparticle-Mediated Thermal Ablation | 7/29/24 | 9/13/24 | Approved | Nanoparticle-Mediated Thermal Ablation |
| 2024-HBL-2514 | Radiofrequency Neurolysis and Pulsed Radiofrequency Therapy for Trigeminal Neuralgia | 7/29/24 | 9/13/24 | Approved | Radiofrequency Neurolysis and Pulsed Radiofrequency Therapy for Trigeminal Neuralgia |
| 2024-HBL-2516 | Mechanical Insufflation-Exsufflation Devices | 7/29/24 | 9/13/24 | Approved | Mechanical Insufflation-Exsufflation Devices |
| 2024-HBL-2517 | Standing Frames | 7/29/24 | 9/13/24 | Approved | Standing Frames |
| 2024-HBL-2519 | Renal Sympathetic Nerve Ablation | 7/29/24 | 9/13/24 | Approved | Renal Sympathetic Nerve Ablation |
| 2024-HBL-1146 | Oral, Pharyngeal and Maxillofacial Surgical Treatment for Obstructive Sleep Apnea or Snoring | 7/18/24 | 9/2/24 | Approved | Oral, Pharyngeal and Maxillofacial Surgical Treatment for Obstructive Sleep Apnea or Snoring |
| 2024-UHC-126 | Supplemental Clinical Criteria | 7/18/24 | 9/2/24 | Approved | Supplemental Clinical Criteria |
| 2024-ACLA-1860 | Phototherapy & Photochemotherapy for skin conditions | 7/18/24 | 9/2/24 | Approved | Phototherapy & Photochemotherapy for skin conditions |
| 2024-ACLA-1861 | Lung Transplants | 7/18/24 | 9/2/24 | Approved | Lung Transplants |
| 2024-ACLA-1864 | Speech Therapy | 7/18/24 | 9/2/24 | Approved | Speech Therapy |
| 2024-ACLA-1865 | Pancreas Transplantation | 7/18/24 | 9/2/24 | Approved | Pancreas Transplantation |
| 2024-ACLA-1866 | Gastroparesis Evaluations | 7/18/24 | 9/2/24 | Approved | Gastroparesis Evaluations |
| 2024-ACLA-1868 | Electrical Muscle Stimulation | 7/18/24 | 9/2/24 | Approved | Electrical Muscle Stimulation |
| 2024-ACLA-1951 | Sacral Nerve Modulation Stimulation | 7/18/24 | 9/2/24 | Approved | Sacral Nerve Modulation Stimulation |
| 2024-LHCC-2227 | Concert Genetics Cardiac Disorders | 7/18/24 | 9/2/24 | Approved | Concert Genetics Cardiac Disorders |
| 2024-LHCC-2234 | Concert Genetics Lung Disorders | 7/18/24 | 9/2/24 | Approved | Concert Genetics Lung Disorders |
| 2024-LHCC-2238 | Concert Genetics Skeletal Dysplasia Rare Bone Disorders | 7/18/24 | 9/2/24 | Approved | Concert Genetics Skeletal Dysplasia Rare Bone Disorders |
| 2024-LHCC-2240 | Concert Genetics Preimplantation Genetic Testing | 7/18/24 | 9/2/24 | Approved | Concert Genetics Preimplantation Genetic Testing |
| 2024-LHCC-2245 | Concert Genetics Multi-system Inherited Disorders | 7/18/24 | 9/2/24 | Approved | Concert Genetics Multi-system Inherited Disorders |
| 2024-LHCC-2302 | Concert Genetics Oncology Algorithmic Testing | 7/18/24 | 9/2/24 | Approved | Concert Genetics Oncology Algorithmic Testing |
| 2024-LHCC-2303 | Concert Genetics Oncology Molecular Analysis of Solid Tumors and Hematologic Malignancies | 7/18/24 | 9/2/24 | Approved | Concert Genetics Oncology Molecular Analysis of Solid Tumors and Hematologic Malignancies |
| 2024-LHCC-2304 | Concert Genetic Pharmacogenetics | 7/18/24 | 9/2/24 | Approved | Concert Genetic Pharmacogenetics |
| 2024-LHCC-2305 | Circulating Tumor DNA and Circulating Tumor Cells (Liquid Biopsy) | 7/18/24 | 9/2/24 | Approved | Circulating Tumor DNA and Circulating Tumor Cells (Liquid Biopsy) |
| 2024-ABH-2365 | AMA XXXX Negative Pressure Would Dressing | 7/18/24 | 9/2/24 | Approved | AMA XXXX Negative Pressure Would Dressing |
| 2024-HBL-2502 | Cell Thx Products for Allogeneic Stem Cell Transp | 7/18/24 | 9/2/24 | Approved | Cell Thx Products for Allogeneic Stem Cell Transp |
| 2024-HBL-2504 | Keratoprosthesis | 7/18/24 | 9/2/24 | Approved | Keratoprosthesis |
| 2024-HBL-599 | Temporomandibular Disorders | 7/18/24 | 9/2/24 | Approved | Temporomandibular Disorders |
| 2024-UHC-959 | Criteria for Medical Necessity Review PCS Policy | 7/18/24 | 9/2/24 | Approved | Criteria for Medical Necessity Review PCS Policy |
| 2024-UHC-523 | Intrauterine Fetal Surgery | 7/11/24 | 8/26/24 | Approved | Intrauterine Fetal Surgery |
| 2024-LHCC-532 | Appropriate UM Professionals | 7/11/24 | 8/26/24 | Approved | Appropriate UM Professionals |
| 2024-LHCC-991 | Concurrent Review | 7/11/24 | 8/26/24 | Approved | Concurrent Review |
| 2024-UHC-2485 | LA Fundus Photography Draft Policy | 7/11/24 | 8/26/24 | Approved | LA Fundus Photography Draft Policy |
| 2024-UHC-2486 | LA Gonioscopy Draft Policy | 7/11/24 | 8/26/24 | Approved | LA Gonioscopy Draft Policy |
| 2024-UHC-2487 | LA Ophthalmic B-Scan Draft Policy | 7/11/24 | 8/26/24 | Approved | LA Ophthalmic B-Scan Draft Policy |
| 2024-UHC-2488 | LA Polycarbonate Lenses LA Draft Policy | 7/11/24 | 8/26/24 | Approved | LA Polycarbonate Lenses LA Draft Policy |
| 2024-UHC-2489 | LA Scanning Computerized Ophthamic Diagnostic Imaging Draft Policy | 7/11/24 | 8/26/24 | Approved | LA Scanning Computerized Ophthamic Diagnostic Imaging Draft Policy |
| 2024-UHC-2490 | LA Specular Microscopy Draft Policy | 7/11/24 | 8/26/24 | Approved | LA Specular Microscopy Draft Policy |
| 2024-UHC-2491 | LA Vision Therapy Draft Policy | 7/11/24 | 8/26/24 | Approved | LA Vision Therapy Draft Policy |
| 2024-UHC-2492 | LA Visual Field Exam Policy | 7/11/24 | 8/26/24 | Approved | LA Visual Field Exam Policy |
| 2024-UHC-2493 | LA YAG Laser Draft | 7/11/24 | 8/26/24 | Approved | LA YAG Laser Draft |