Medicaid Services

Adult Denture Services

HOW TO ACCESS:

Dentist

ELIGIBILITY:

Medicaid recipients 21 years of age and older.

(Adults, 21 and over, certified as Qualified Medicare Beneficiary (QMB), Specified Low Income Medicare Beneficiary (SLMB) only, PACE, Take Charge Plus or other programs with limited benefits are not eligible for dental services.)

COVERED SERVICES:

Examination, x-rays (are only covered if in conjunction with the construction of a Medicaid-authorized denture) dentures, denture relines, and denture repairs.

Only one complete or partial denture per arch is allowed in an eight-year period.  The partial denture must oppose a full denture.  Two partials are not covered in the same oral cavity (mouth).  Additional guidelines apply.

COMMENTS:

DentaQuest and MCNA Dental administer the dental benefits for eligible Medicaid recipients. Contact your plan to locate a network provider and for questions about covered dental services.

CONTACT:

Andrea Perry        225/342-7476

Tiffany Hayes         225/342-7877

MCNA Dental         1-855-702-6262

Visit MCNA online at www.mcnala.net 

DentaQuest            1-800-685-0143

Visit DentaQuest online at www.dentaquest.com 

Adult Waiver Dental Services

HOW TO ACCESS:

Dentist

ELIGIBILITY:

Medicaid recipients 21 years of age and older enrolled in New Opportunities Waiver, Residential Options Waiver or Supports Services Waiver.

COVERED SERVICES:

The Adult Waiver Dental Program provides coverage of certain diagnostic; preventive; restorative; endodontic; periodontic; removable prosthodontic; maxillofacial prosthetic; oral and maxillofacial surgery; orthodontic; and adjunctive general services.  Specific policy guidelines apply.

COMMENTS:

DentaQuest and MCNA Dental administer the dental benefits for eligible Medicaid recipients. Contact your plan to locate a network provider and for questions about covered dental services.

Beneficiaries will receive comprehensive dental coverage through their existing Medicaid dental plan. If families are unsure of which plan the beneficiary is enrolled with, contact Healthy Louisiana at 1-855-229-6848. 

CONTACT:

Andrea Perry        225/342-7476

Tiffany Hayes         225/342-7877

MCNA Dental         1-855-702-6262

Visit MCNA online at www.mcnala.net 

DentaQuest            1-800-685-0143

Visit DentaQuest online at www.dentaquest.com 

Applied Behavioral Analysis (ABA)

Behavior analysis is based on a scientific study of how people learn. By doing research, techniques have been developed that increase useful behavior (including communication) and reduce harmful behavior. Applied behavior analysis (ABA) therapy uses these techniques. ABA is helpful in treating autism spectrum disorders.

HOW TO ACCESS:

Medicaid enrolled ABA provider.

ELIGIBILITY:

Age from birth up to 21 years of age; and

(1) exhibit the presence of excesses and/or deficits of behaviors that significantly interfere with home or community activities (examples include, but are not limited to aggression, self-injury, elopement, etc.);

(2) be diagnosed by a qualified health care professional with a condition for which ABA-based therapy services are recognized as therapeutically appropriate, including autism spectrum disorder;

(3) have a comprehensive diagnostic evaluation by a qualified health care professional; and

(4) have a prescription for ABA-based therapy services ordered by a qualified health care professional.

COVERED SERVICES:

ABA-based therapy services shall be rendered in accordance with the individual's approved treatment plan.

COMMENTS:

All medically necessary services must be prescribed by a physician and Prior Authorization is required.  The provider of services will submit requests for Prior Authorization..

RESOURCES:

• Applied Behavior Analysis-Based Therapy Services - Place of Service Limitations LAC 50:XV.301
• Fee Schedule
• Secondary PA Requirements
• Applied Behavior Analysis Provider Manual
• Qlarant Medical Record Requests
• Arranging ABA Services

CONTACT:

Crystal Faison

(225) 342-8233, or Toll-Free 1(844) 423-4762
Email: appliedbehavioranalysis@la.gov

Audiological

See Early Steps, Hospital-Outpatient Services, Rehabilitation Clinic Services, Physician/Professional Services, Therapy Services

Behavioral Health - Adults

HOW TO ACCESS:

 ELIGIBILITY:

Medicaid eligible adult.

Adults eligible to receive mental health rehabilitation services under Medicaid State Plan  include those who meet one of the following criteria:

• Must have a mental health diagnosis and
• Must be assessed by an LMHP

Members receiving CPST and/or PSR:

• Must have at least a level of care of three on the LOCUS.
• Must have a rating of three or greater on the functional status domain on the level of care utilization system (LOCUS).

Members receiving IPS and PCS must be

• 21 years and older:
• Transitioned from a nursing facility or been diverted from nursing facility level of care through the My Choice Louisiana program. 

For more information, please refer to the BHS Provider Manual.

COVERED SERVICES:

1. Community Psychiatric Support & Treatment (CPST)
2. Psychosocial Rehabilitation (PSR)
3. Crisis Intervention (CI)
4. Assertive Community Treatment (ACT)
5. Crisis Responses Services
a. Mobile Crisis Response (MCR)
b. Behavioral Health Crisis Care (BHCC)
c. Community Based Crisis Service (CBCS)
6. Crisis Stabilization (CS)
7. Individual Placement and Supports (IPS)
8. Personal Care Services (PCS)
9. Peer Support Services (PSS)
10. Outpatient Therapy with Licensed Practitioners (medication management, individual, family, and group counseling)
11. Addiction Services (outpatient, residential, and inpatient)
12. Psychiatric Inpatient Hospital 18-21 years and over 65 years of age

COMMENTS:

Adult Behavioral Health services are administered by the Healthy Louisiana Plans. CPST, PSR, CI follow-up, ACT, CBCS, CS, IPS, PCS, and PSS must be Prior Authorized.

Chemotherapy

See Hospital-Outpatient Services; Physician/Professional Services

HOW TO ACCESS:

Hospital

Physician's office or clinic

ELIGIBILITY:

All Medicaid Recipients.

COVERED SERVICES:

Chemotherapy administration and treatment drugs, as prescribed by physician.

COMMENTS:

** Please Note: The contact person and number provided should not be utilized for making appointments. Members that are enrolled with one of the Healthy Louisiana plans should contact Healthy Louisiana via the information below:

https://www.myplan.healthy.la.gov/en 

Phone

Monday through Friday from 8:00 a.m. to 5:00 p.m.
Call 1-855-229-6848.

For hearing impaired (TTY) please call 

1-855-526-3346.

Mail 

Healthy Louisiana
P.O. Box 1097
Atlanta, GA 30301-9913 

Fax

1-888-858-3875

CONTACT:

Sharetha Brown

225/219-2555

Please utilize the above contact for questions related to Fee For Service coverage. 

Chiropractic

HOW TO ACCESS:

EPSDT Medical Screening Provider/PCP

ELIGIBILITY:

Medicaid recipients 0 through 20 years of age.

COVERED SERVICES:

Spinal manipulations.

COMMENTS:

Medically necessary manual manipulations of the spine when the service is provided as a result of a referral from an EPSDT medical screening provider or Primary Care Provider (PCP).

** Please Note: The contact person and number provided should not be utilized for making appointments. Members that are enrolled with one of the Healthy Louisiana plans should contact Healthy Louisiana via the information below:

https://www.myplan.healthy.la.gov/en

Phone

Monday through Friday from 8:00 a.m. to 5:00 p.m. Call 1-855-229-6848.

For hearing impaired (TTY) please call

1-855-526-3346.

Mail

Healthy Louisiana

P.O. Box 1097

Atlanta, GA 30301-9913

Fax

1-888-858-3875

Contact

Sharetha Brown

225/219-2555

Please utilize the above contact for questions related to Fee For Service coverage.

Coordinated System of Care (CSoC) - Home and Community Based Services Waiver

HOW TO ACCESS:

Magellan Health Services of Louisiana, 1-800-424-4399

ELIGIBILITY:

Any child/youth experiencing a serious emotional disturbance who is at risk of out-of home placement.  A recipient must be under the age of 22 and meet the level of care or level of need  through a Child and Adolescent Needs and Strengths (CANS) comprehensive assessment

COVERED SERVICES:

1. WRAP Around Planning
2. Parent Support & Training
3. Youth Support & Training
4. Independent Living/Skills Building
5. Short Term Respite Care
6. Crisis Stabilization
7. Case Conference
8. Treatment Planning

COMMENTS:

CSoC services are administered by Magellan Health Services of Louisiana.

Dental

See Adult Denture Services; Adult Waiver Dental Services; and EPSDT Dental Services

Durable Medical Equipment (DME)

HOW TO ACCESS:

Physician

ELIGIBILITY:

All Medicaid recipients.

COVERED SERVICES:

Medical equipment and appliances such as wheelchairs, leg braces, etc.

Medical supplies such as ostomy supplies, etc.

Diapers and blue pads are only reimbursable as durable medical equipment items for Medicaid recipients 4 through 20 years of age.  

COMMENTS:

All services must be prescribed by a physician and must be Prior Authorized.

DME providers will arrange for the Prior Authorization request.

CONTACT:

Irma Gauthier
225/342-5691

EarlySteps (Infant & Toddler Early Intervention Services

HOW TO ACCESS:
Contact the Office for Citizens with Developmental Disabilities or call 1-866-783-5553.

ELIGIBILITY:

1. Children ages birth to three who have a developmental delay of at least 1.5 SD (standard deviations) below the mean in two areas of development listed below:

a. cognitive development
b. physical development (including vision & hearing)
c. communication development
d. social or emotional development
e. adaptive skills development (also known as self-help or daily living skills)

2. Children with a diagnosed medical condition with a high probability of resulting in developmental delay.

COVERED SERVICES:

Medicaid Covered Services

• Family Support Coordination (Service Coordination)
• Occupational Therapy
• Physical Therapy
• Speech/Language Therapy
• Psychology
• Audiology
• Cognitive Development
• Physical Development (including vision and hearing)
• Communication Development
• Social or Emotional Development
• Adaptive Skills Development (also known as self-help or daily living skills)

EarlySteps also provides the following services, not covered by Medicaid:

• Nursing Services/Health Services (Only to enable an eligible child/family to benefit from the other EarlySteps services).
• Medical Services for diagnostic and evaluation purposes only.
• Special Instruction
• Vision Services
• Assistive Technology devices and services
• Social Work 
• Counseling Services/Family Training
• Transportation
• Nutrition
• Sign language and cued language services.

COMMENTS:

All services are provided through a plan of care called the Individualized Family Service Plan. Early Intervention is provided through EarlySteps in conformance with Part C of the Individuals with Disabilities Education Act (IDEA).

CONTACT:

Caroline Nailor-Oglesby
(225) 342-8853

EPSDT Behavioral Health Services

HOW TO ACCESS:

Medicaid eligible youth who meets the medical necessity criteria for behavioral health services as determined by a licensed
mental health professional (LMHP) or physician.

ELIGIBILITY:

Meets medical necessity criteria for rehabilitation services for children under the age of 21.

Children and youth eligible to receive mental health rehabilitation (MHR) services under Medicaid State Plan include those who meet one of the following criteria and is 21 years and older:
                   • Must be assessed by a licensed mental health professional.

Members receiving CPST and/or PSR, ages 6 through 18 years of age, must be assessed using the CALOCUS.

Members receiving CPST and/or PSR, ages 19 through 20 years of age, must be assessed using the LOCUS.

Members who receive Multi-Systemic Therapy, Homebuilders, Functional Family Therapy and Functional Family
Therapy-Child Welfare are not required to be assessed using the CALOCUS.

COVERED SERVICES:

1. Community Psychiatric Support & Treatment (CPST)
2. Psychosocial Rehabilitation (PSR)
3. Crisis Intervention
4. Crisis Stabilization
5. Outpatient Therapy with Licensed Practitioners (medication management, individual, family, and group counseling)
6. Therapeutic Group Home
7. Psychiatric Residential Treatment Facility (PRTF)
8. Psychiatric Inpatient Hospital
9. Addiction Services (outpatient, residential, and inpatient)
10. Multi-systemic Therapy (MST)
11. Functional Family Therapy (FFT)
12. Homebuilders (HB)
13. Assertive Community Treatment (ACT)
14. Child Parent Psychotherapy (CPP)
15. Parent-child interaction therapy (PCIT)
16. Preschool PTSD Treatment (PPT) and Youth PTSD Treatment (YPT)
17. Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)
18. Eye Movement Desensitization and Reprocessing (EMDR) Therapy
19. Coordinated System of Care (CSoC) (NOTE: Please see the CSoC section)
20. Mobile Crisis Response (MCR)
21. Community Brief Crisis Support (CBCS)

COMMENTS:

EPSDT Behavioral Health services are administered by the Healthy Louisiana Plans.

CPST, PSR, MST, FFT, HB, CBCS, and ACT must be Prior Authorized.

EPSDT Dental Services

HOW TO ACCESS:

Dentist

ELIGIBILITY:

Medicaid recipients 0 through 20 years of age.

COVERED SERVICES:

The EPSDT Dental Program provides coverage of certain diagnostic; preventive; restorative; endodontic; periodontic; removable prosthodontic; maxillofacial prosthetic; oral and maxillofacial surgery; orthodontic; and adjunctive general services.  Specific policy guidelines apply.

Comprehensive Orthodontic Treatment (braces) are paid only when there is a cranio-facial deformity, such as cleft palate, cleft lip, or other medical conditions which possibly results in a handicapping malocclusion. If such a condition exists, the recipient should see a Medicaid-enrolled orthodontist.  Patients having only crowded or crooked teeth, spacing problems or under/overbite are not covered for braces, unless identified as medically necessary.

COMMENTS:

DentaQuest and MCNA Dental administer the dental benefits for eligible Medicaid recipients. Contact your plan to locate a network provider for questions about covered dental services.

CONTACT:

Andrea Perry          225/342-7476

Tiffany Hayes          225/342-7877

MCNA Dental          1-855-702-6262

Visit MCNA online at www.mcnala.net 

DentaQuest             1-800-685-0143

Visit DentaQuest online at www.DentaQuest.com 

EPSDT Personal Care Services

(See Long Term--Personal Care Services (LT-PCS) for Medicaid beneficiaries ages 65 or older, or age 21 or older with disabilities)

Physician and Personal Care Attendant Agencies

ELIGIBILITY:

The person must be age birth through 20 years (EPSDT eligible) and have been prescribed medically necessary, age appropriate EPSDT-PCS by a practitioner (physician, advance practice nurse, or physician assistant). The practitioner shall specify the health/medical condition that necessitates EPSDT-PCS. An EPSDT eligible shall meet medical necessity criteria which shall be based on functional and medical eligibility and impairment in at least two activities of daily living. To establish medical necessity, the EPSDT eligible must be of an age at which the tasks to be performed by the PCS provider would ordinarily be performed by the individual, if not for being disabled due to illness or injury.

Children’s Choice waiver services and PCS may be performed on the same date, but not at the same time. If the beneficiary is receiving home health, respite, and/or any other related service, the PCS provider cannot provide service at the same time as the other Medicaid covered service provider.

COVERED SERVICES:

• Basic personal care – toileting & grooming activities.
• Assistance with bladder and/or bowel requirements or problems.
• Assistance with eating and food preparation.
• Performance of incidental household chores, only for the beneficiary.
• Accompanying, not transporting, beneficiary to medical appointments.
• Does NOT cover any medical tasks such as medication administration, tube feedings, urinary catheters, ostomy or tracheostomy care.

COMMENTS:

The Personal Care Agency must submit the Prior Authorization request. 

Beneficiaries receiving Support Coordination (Case Management Services) must also have their PCS Prior Authorized by Gainwell Technologies. 

PCS is not subject to service limits. Units approved will be based on medical necessity and the need for covered services.

Beneficiaries receiving Personal Care Services must have practitioner's prescription and meet medical criteria.

Does not include medical tasks.

Provided by licensed providers enrolled in Medicaid to provide personal care services.

CONTACT:

Norma Seguin           225/342-7513

EPSDT Screening Services

(Child Health preventive services)

Physician

ELIGIBILITY:

All Medicaid recipients 0 through 20 years of age.

COVERED SERVICES:

• A comprehensive health and developmental history (including assessment of physical and mental health and development)
• A comprehensive unclothed physical exam or assessment
• Appropriate immunizations according to age and health history
• Laboratory tests* (including age-appropriate screenings for newborns, iron deficiency anemia, blood lead levels, dyslipidemia, and sexually transmitted infections)
• Health education (including anticipatory guidance)
• Vision Screening
• Hearing Screening
• Dental Screening
• Developmental Screening
• Autism Screening
• Perinatal Depression Screening

COMMENTS:

Recipients receive their screening services from the primary care provider (PCP) or appropriate health care provider.

Screening services are provided according to the “Recommendations for Preventive Pediatric Health Care” promulgated by the American Academy of Pediatrics (AAP)/Bright Futures with three exceptions:

1. This policy only applies to Medicaid beneficiaries under the age of 21. (The AAP/Bright Futures periodicity schedule provides guidance for patients through age 21);
2. Perinatal depression screening is a recommended, but not required, component of the EPSDT preventive screening; and
3. There are stricter requirements for lead assessment and blood lead screening in keeping with the Louisiana Office of Public Health recommendations.

CONTACT:

Norma Seguin       225/342-7513

If you need a service that is not listed above or need help finding a provider, call the Medicaid Specialty Care Help Desk at (toll free) 1(888) 758-2220.

Family Planning Services - Take Charge Plus

HOW TO ACCESS:

Any Medicaid provider who offers family planning services. For assistance with locating a provider, click here.

ELIGIBILITY:

All Louisiana residents of child bearing age regardless of gender with an income at or below 138% of the Federal Poverty level. Pregnant women are excluded from this program.

COVERED SERVICES:

Family planning related services and care related to:

• Birth control (pills, implants, injections, condoms, and IUDs)
• Cervical cancer screening and treatment for most abnormal results
• Contraceptive counseling and education
• Prescriptions, and follow-up visits to treat STIs 
• Treatment of major complications from certain family planning procedures
• Voluntary sterilization for males and females (over age 21)
• Vaccines for both males and females for the prevention of HPV
• Transportation to family planning appointments

COMMENTS:

Take Charge Plus is limited to family planning services and family planning related services.  There are no enrollment fees, no premiums, co-payments or deductibles.  All Medicaid providers including American Indian "638" Clinics, RHCs and FQHCs are reimbursed at established fee-for-service rates published in the Take Charge Plus fee schedule.

** Please Note: The contact person and number provided should not be utilized for making appointments. Members that are enrolled with one of the Healthy Louisiana plans should contact Healthy Louisiana via the information below:

https://www.myplan.healthy.la.gov/en

Phone

Monday through Friday from 8:00 a.m. to 5:00 p.m. Call 1-855-229-6848.

For hearing impaired (TTY) please call

1-855-526-3346.

Mail

Healthy Louisiana

P.O. Box 1097

Atlanta, GA 30301-9913

Fax

1-888-858-3875

CONTACT:

Sharetha Brown

225/219-2555

Please utilize the above contact for questions related to Fee For Service coverage. 

Family Planning Services in Physician's Office

HOW TO ACCESS:
Physician or Healthcare Professional

ELIGIBILITY:

All Medicaid recipients.

COVERED SERVICES:

Professional medical services including those of a physician, nurse midwife, nurse practitioner, clinical nurse specialists, physician assistant.

Certain family planning services are covered when provided in a physician's office.

COMMENTS:

Some services require Prior Authorization.  Providers will submit requests for Prior Authorization to  Gainwell Technology.

Services are subject to limitations and exclusions. Your physician or healthcare professional can help with this.

** Please Note: The contact person and number provided should not be utilized for making appointments. Members that are enrolled with one of the Healthy Louisiana plans should contact Healthy Louisiana via the information below:

https://www.myplan.healthy.la.gov/en

Phone

Monday through Friday from 8:00 a.m. to 5:00 p.m. Call 1-855-229-6848.

For hearing impaired (TTY) please call

1-855-526-3346.

Mail

Healthy Louisiana

P.O. Box 1097

Atlanta, GA 30301-9913

Fax

1-888-858-3875

CONTACT:

Immunizations: Norma Seguin  225/342-7513

Professional Services: Sharetha Brown  225/219-2555

Federally Qualified Health Centers (FQHC)

HOW TO ACCESS:

Nearest FQHC

The American Indian Clinic

ELIGIBILITY:

All Medicaid recipients.

COVERED SERVICES:

Professional medical services furnished by physicians, nurse practitioners, physician assistants, nurse midwives, clinical social workers, clinical psychologists, and dentists.

COMMENTS:

There are 3 components that may be provided: 1) Encounter visits; 2) EPSDT Screening Services; and 3) EPDST Dental, and Adult Denture Services.

CONTACT:

Irma Gauthier
225/342-5691

Free Standing Birthing Centers

HOW TO ACCESS:

Certified Nurse Midwife or Licensed Midwife

ELIGIBILITY:

All Medicaid eligible pregnant women.

COVERED SERVICES:

Vaginal delivery services for females who have had a low risk, normal pregnancy, prenatal care and that are expected to have an uncomplicated labor and normal vaginal delivery.

COMMENTS:

A Free Standing Birthing Center is a free standing facility, separate from a hospital.

Stays for delivery are usually less than 24 hours.

Epidural anesthesia is not provided for deliveries at Free Standing Birthing Centers.

** Please Note: The contact person and number provided should not be utilized for making appointments. Members that are enrolled with one of the Healthy Louisiana plans should contact Healthy Louisiana via the information below:

https://www.myplan.healthy.la.gov/en

Phone

Monday through Friday from 8:00 a.m. to 5:00 p.m. Call 1-855-229-6848.

For hearing impaired (TTY) please call

1-855-526-3346.

Mail

Healthy Louisiana

P.O. Box 1097

Atlanta, GA 30301-9913

Fax

1-888-858-3875

CONTACT:

Sharetha Brown

225/219-2555

Hearing Aids

See Durable Medical Equipment

HOW TO ACCESS:

Durable Medical Equipment Provider

ELIGIBILITY:

Medicaid recipients 0 to 20 years of age.

COVERED SERVICES:

Hearing Aids and any related ancillary equipment such as earpieces, batteries, etc.  Repairs are covered if the Hearing Aid was paid for by Medicaid.

COMMENTS:

All services must be Prior Authorized and the DME provider will arrange for the request of Prior Authorization.

CONTACT:

Irma Gauthier

225/342-5691

Hemodialysis Services

See Hospital-Outpatient Services

HOW TO ACCESS:

Dialysis Centers

Hospitals

ELIGIBILITY:

All Medicaid recipients.

COVERED SERVICES:

Dialysis treatment (including routine laboratory services); medically necessary non-routine lab services; and medically necessary injections.

CONTACT:

Justin Owens

225/342-6888

Home Health

Home Health Basic

HOW TO ACCESS:

A physician, nurse practitioner, clinical nurse specialist, or physician assistant licensed, certified, registered, or otherwise authorized to order home healthcare services consistent with State law. This is referred to as an Authorized Healthcare Provider.

ELIGIBILITY:

All Medicaid recipients.

Medically Needy (Type Case 20 & 21) recipients are not eligible for Aide Visits, Physical Therapy, Occupational Therapy, Speech/Language Therapy.

COVERED SERVICES:

• Intermittent/part-time nursing services including skilled nurse visits.
• Aide Visits.
• Physical Therapy Services
• Occupational Therapy
• Speech/Language Therapy

COMMENTS:

Recipients receiving Home Health must have an Authorized Healthcare Provider’s prescription and signed plan of care.

PT, OT, and Speech/Language Therapy require Prior Authorization.

Crisis Response Team – for Medicaid recipients 0 through 20 AND under a waiver program (Supports, ROW, NOW, Children’s Choice) AND not receiving prescribed medically necessary intermittent nursing services for 2 consecutive weeks

CONTACT:

Justin Owens        225/342-6888

Home Health Extended

HOW TO ACCESS:

A physician, nurse practitioner, clinical nurse specialist, or physician assistant licensed, certified, registered, or otherwise authorized to order home healthcare services consistent with State law. This is referred to as an Authorized Healthcare Provider.

ELIGIBILITY:

Medicaid recipients 0 to 20 years of age.

COVERED SERVICES:

Multiple hours of skilled nurse services.

All medically necessary medical tasks that are part of the plan of care can be administered in the home.

COMMENTS:

Recipients receiving extended nursing services must have a letter of medical necessity and an Authorized Healthcare Provider's prescription.

Extended Skilled nursing services require Prior Authorization.

CONTACT:

Justin Owens

225/342-6888

Home Health: Crisis Response Team

ELIGIBILITY:

Medicaid recipients 0 to 20 years of age that are under the following waiver programs AND

Who are not receiving some or all of the hours of extended home health or intermittent nursing services as authorized by the program requirements.

WAIVER PROGRAMS:

            • Children's Choice Waiver (CCW)

            • New Opportunities Waiver (NOW)

            • Supports Waiver (SW)

            • Residential Options Waiver (ROW)


HOW TO ACCESS:

Email: crisisresponseteam@la.gov

Telephone: 1-866-729-0017

Hospice

HOW TO ACCESS:

Hospice Provider/Physician

ELIGIBILITY:

All Medicaid recipients.

Hospice eligibility information: 1-800-877-0666, Option 2

COVERED SERVICES:

Medicare allowable services.


CONTACT:

Justin Owens

225/342-6888

Hospital

Inpatient and Outpatient Services, including Emergency Room Services

HOW TO ACCESS  SERVICES:
Physician/Hospital

Eligibility:

All Medicaid recipients.

Medically Needy (Type Case 20 & 21) under age 22 are not eligible for Inpatient Psychiatric Services.

COVERED SERVICES:
Inpatient and Outpatient Hospital Services, including Emergency Room Services

COMMENTS:
All Questions Regarding Denied Claims and/or Bills for Inpatient and Outpatient Hospital Services, including emergency Room Services.

CONTACT:
Recipients should first contact the provider, then may contact and MMIS Staff Member at (225) 342-3855 if the issue cannot be resolved.

Providers should contact Provider Relations at 1-800-473-2783.

Hospital - Emergency Room Services

Inpatient and Outpatient Services, including Emergency Room Services

HOW TO ACCESS  SERVICES:
Physician/Hospital

Eligibility:
All Medicaid recipients.

COVERED SERVICES:
Emergency Room Services

COMMENTS:
No service limits

CONTACT:

Providers: ProviderRelations@la.gov

Members: Healthy@la.gov 

Hospital - Inpatient Services

Hospital-Inpatient Services

HOW TO ACCESS:

Physician/Hospital

ELIGIBILITY:

All Medicaid recipients.

Medically Needy (Type Case 20 & 21) under age 22 are not eligible for Inpatient Psychiatric Services.

COVERED SERVICES:

Inpatient hospital care needed for the treatment of an illness or injury which can only be provided safely & adequately in a hospital setting.

Includes those basic services that a hospital is expected to provide.


CONTACT:

Providers: ProviderRelations@la.gov 

Members: Healthy@la.gov

Hospital - Outpatient Services

HOW TO ACCESS:

Physician/Hospital

ELIGIBILITY:

All Medicaid recipients.

COVERED SERVICES:

• Diagnostic & therapeutic outpatient services, including outpatient surgery and rehabilitation services.
• Therapeutic and diagnostic radiology services.
• Chemotherapy
• Hemodialysis

COMMENTS:

Outpatient rehabilitation (physical therapy, occupational therapy and speech therapy) require Prior Authorization.  Provider will submit request for Prior Authorization.

CONTACT:

Providers: ProviderRelations@la.gov

Members: Healthy@la.gov

Immunizations

See FQHCs, EPSDT Screening Services, Physicians/Professional Services, Rural Health Clinics, Pharmacy Services

Laboratory Tests & Radiology Services

HOW TO ACCESS:

Physician

ELIGIBILITY:

All Medicaid recipients.

COVERED SERVICES:

Most diagnostic testing and radiological services ordered by the attending or consulting physician.

Portable (mobile) x-rays are covered only for recipients who are unable to leave their place of residence without special transportation or assistance to obtain physician ordered x-rays.

COMMENTS:

All requests for any radiology services requiring prior approval are initiated by the ordering physician. Recipients may follow up with the ordering physician for the status of any ordered radiology service.

** Please Note: The contact person and number provided should not be utilized for making appointments. Members that are enrolled with one of the Healthy Louisiana plans should contact Healthy Louisiana via the information below:

https://www.myplan.healthy.la.gov/en

Phone

Monday through Friday from 8:00 a.m. to 5:00 p.m. Call 1-855-229-6848.

For hearing impaired (TTY) please call

1-855-526-3346.

Mail

Healthy Louisiana

P.O. Box 1097

Atlanta, GA 30301-9913

Fax

1-888-858-3875

CONTACT:

Sharetha Brown        

225/219-2555

Long Term - Personal Care Services (LT-PCS)

(See EPSDT Personal Care Services - for children ages 0 to 21)

HOW TO ACCESS:

Louisiana Options in Long-Term Care
1-877-456-1146

ELIGIBILITY:

All Medicaid recipients age 65 or older, or age 21 with disabilities (meets Social Security Administration disability criteria), must meet the medical standards for admission to a nursing facility and additional targeting criteria, and be able to participate in his/her care and direct the services provided by the worker independently or through a responsible representative. Applicants must require at least limited assistance with at least one Activity of Daily Living.

COVERED SERVICES:

• Basic personal care-toileting & grooming activities.
• Assistance with bladder and/or bowel requirements or problems.
• Assistance with eating and food preparation.
• Performance of incidental household chores, only for the recipient.
• Accompanying, not transporting, recipient to medical appointments.
• Grocery shopping, including personal hygiene items.

COMMENTS:

Recipients or the responsible representative must request the service.

This program is not a substitute for existing family and/or community supports, but is designed to supplement available supports to maintain the recipient in the community.

Once approved for the services, the selected PCS Agency must obtain Prior Authorization.

Amount of services approved will be based on assessment of assistance needed to perform daily living.

Provided by PCS agencies enrolled in Medicaid.

CONTACT:

Office of Aging and Adult Services Helpline
1-866-758-5035

Midwife Services (Certified Nurse Midwife)

See Physician/Professional Services; FQHC; Rural Health Clinics

Nurse Practitioners/Clinic Nurse Specialists

See Physician/Professional Services; FQHC; Rural Health Clinics

Nursing Facility

HOW TO ACCESS:

Office of Aging and Adult Services (OAAS)

Contact: Louisiana Options in Long Term Care (Conduent), 1-877-456-1146

ELIGIBILITY:

Medicaid recipients and persons who would meet Medicaid Long Term Care financial eligibility requirements and who meet nursing facility level of care as determined by OAAS.

COVERED SERVICES:

Skilled Nursing or medical care and related services; rehabilitation needed due to injury, disability, or illness; health-related care and services (above the level of room and board) not available in the community, needed regularly due to a mental or physical; condition.

CONTACT:

Louisiana Options in Long Term Care (Conduent), 1-877-456-1146

Occupational Therapy Services

See EarlySteps; Therapy Services; Rehabilitation Clinic Services; Hospital-Outpatient Services; Home Health

Optical Services

HOW TO ACCESS:

Optometrist, Opthamologist or Optical Supplier

ELIGIBILITY:

All Medicaid recipients.

COVERED SERVICES:

Recipients 0 through 20
Examinations and treatment of eye conditions, including examinations for vision correction, refraction error.

Regular eyeglasses when they meet a certain minimum strength requirement.  Medically necessary specialty eyewear and contact lenses with prior authorization.  Contact lenses are covered if they are the only means for restoring vision.

Other related services, if medically necessary.

Recipients 21 and over
Examinations and treatment of eye conditions, such as infections, cataracts, etc.

If the recipient has both Medicare and Medicaid, some vision related services may be covered.  The recipient should contact Medicare for more information since Medicare would be the primary payer.

COMMENTS:

Recipients 0 to 21
Specialty eyewear and contact lenses, if medically necessary for EPSDT eligibles requires Prior Authorization.  The provider will submit requests for the Prior Authorization.  A prior authorization approval does not guarantee patient eligibility.

Prescriptions are required for all glasses/contacts. After a prescription is obtained, the recipient may see an optical supplier to receive the glasses/contacts.

Recipients 21 and over
NON-COVERED SERVICES:

• Routine eye examinations for vision correction
• Routine eye examinations for refraction error
• Eyeglasses

** Please Note: The contact person and number provided should not be utilized for making appointments. Members that are enrolled with one of the Healthy Louisiana plans should contact Healthy Louisiana via the information below:

https://www.myplan.healthy.la.gov/en

Phone

Monday through Friday from 8:00 a.m. to 5:00 p.m. Call 1-855-229-6848.

For hearing impaired (TTY) please call

1-855-526-3346.

Mail

Healthy Louisiana

P.O. Box 1097

Atlanta, GA 30301-9913

Fax

1-888-858-3875

CONTACT:
Ophthalmology:

Sharetha Brown

225/219-2555

Eyewear:

Irma Gauthier

225/342-5691

Orthodontic Services

See Adult Denture Services; Adult Waiver Dental Services; and EPSDT Dental Services

Pediatric Day Health Care (PDHC)

HOW TO ACCESS:

Physician or PDHC Agencies

ELIGIBILITY:

Medicaid recipients 0 through 20 who have a medically fragile condition and who require nursing supervision and possibly therapeutic interventions all or part of the day due to a medically complex condition.

COVERED SERVICES:

Nursing care, Respiratory care, Physical Therapy, Speech-language therapy, Occupational Therapy, Social Services, personal care services and transportation to and from PDHC facility.

COMMENTS:

The PDHC facility must submit the Prior Authorization request.

In order to receive PDHC, the recipient must have a prescription from their prescribing physician and meet the medical criteria

PDHC may be provided up to seven days per week and up to 12 hours per day for Medicaid recipients as documented by the recipient's Plan of Care.

Services are provided by licensed providers enrolled in Medicaid to provide PDHC services.

The following services are not covered - before and after school care; medical equipment, supplies and appliances; parenteral or enteral nutrition; infant food or formula.

Prescribed medications are to be provided each day by recipient's parent/guardian.


CONTACT:

Norma Seguin             225/342-7513

PACE - Program for All Inclusive Care for the Elderly

*Program available in Greater New Orleans, Baton Rouge, and Lafayette area.

HOW TO ACCESS:

Office of Aging and Adult Services (OAAS)
Contact: PACE GNO at (504) 945-1531
Franciscan PACE Baton Rouge at (225) 490-0604
Franciscan PACE Lafayette at (337) 470-4500
Trinity Health Alexandria at (318) 206-1020

ELIGIBILITY:

Participants are persons age 55 years or older, live in the PACE provider service area and are certified to meet nursing facility level of care and financially eligible for Medicaid long term care. Participation is voluntary and enrollees may disenroll at any time.  

COVERED SERVICES:

ALL Medicaid and Medicare services, both acute and long-term care

COMMENTS:

Emphasis is on enabling participants to remain in community and enhance quality of life.
Interdisciplinary team performs assessment and develops individualized plan of care.
Each PACE program serves a specific geographic region.
PACE programs bear financial risk for all medical support services required for enrollees.
PACE programs receive a monthly capitated payment for Medicaid and Medicare eligible enrollees.

CONTACT:

PACE GNO at (504) 945-1531
Franciscan PACE Baton Rouge at (225)490-0604
Franciscan PACE Lafayette at (337) 470-4500
Trinity Health Alexandria at (318) 206-1020

Pharmacy Services

HOW TO ACCESS:

Pharmacies

ELIGIBILITY:

All Medicaid recipients except some who are Medicare/Medicaid eligible.  Recipients who are full benefit dual eligible (Medicare/Medicaid) received their pharmacy benefits through Medicare Part D. Recipients enrolled with an MCO; with only behavioral health services, receive prescription benefits through the fee-for-service Medicaid program.

COVERED SERVICES:

Covers prescription drugs, except:

• Cosmetic drugs (Except Accutane);
• Cough & cold preparations;
• Anorexics (Except for Xenical);       
• Fertility drugs when used for fertility treatment;
• Experimental drugs;
• Compounded prescriptions;
• Drug Efficacy Study Implementation (DESI) drugs;
• Erectile Dysfunction (ED) Medications
• Over the counter (OTC) drugs, with some exceptions;

COMMENTS:

Co-payments ($0.50-$3.00) are required except for some recipient categories.

NO co-payments for the following recipients:

• under age 21
• Pregnant women
• Long Term Care.recipients
• American Indians/Alaska Natives
• Waiver categories

Copay shall not exceed 5% of the family’s income applied on a monthly basis.

Prescription limits: 4 per calendar month (The physician can approve an override for this limit when medically necessary). Limits do not apply to recipients under age 21, pregnant women, or those in Long Term Care.

Prior Authorization is required for some drugs. Children are not exempt from this process. The PDL can be accessed at https://ldh.la.gov/assets/HealthyLa/Pharmacy/PDL.pdf. 


For general pharmacy questions: 1-800-437-9101

Physical Therapy

See EarlySteps; Therapy Services; Rehabilitation Clinic Services; Hospital-Outpatient Services; Home Health

Physician Assistants

See Physician/Professional Services; FQHC; Rural Health Clinics

Physician/Professional Services

HOW TO ACCESS:
Physician or Healthcare Professional

ELIGIBILITY:

All Medicaid recipients.

COVERED SERVICES:

Professional medical services including those of a physician, nurse midwife, nurse practitioner, clinical nurse specialists, physician assistant.

Certain family planning services are covered when provided in a physician's office.

COMMENTS:

Some services require Prior Authorization.  Providers will submit requests for Prior Authorization to  Gainwell Technology.

Services are subject to limitations and exclusions. Your physician or healthcare professional can help with this.

** Please Note: The contact person and number provided should not be utilized for making appointments. Members that are enrolled with one of the Healthy Louisiana plans should contact Healthy Louisiana via the information below:

https://www.myplan.healthy.la.gov/en

Phone

Monday through Friday from 8:00 a.m. to 5:00 p.m. Call 1-855-229-6848.

For hearing impaired (TTY) please call

1-855-526-3346.

Mail

Healthy Louisiana

P.O. Box 1097

Atlanta, GA 30301-9913

Fax

1-888-858-3875

CONTACT:

Immunizations: Norma Seguin  225/342-7513

Professional Services: Sharetha Brown  225/219-2555

Podiatry Services

HOW TO ACCESS:

Podiatrist

ELIGIBILITY:

All Medicaid recipients.

COVERED SERVICES:

Office visits.

Certain radiology & lab procedures and other diagnostic procedures.

COMMENTS:

Some Prior Authorization, exclusions, and restrictions apply.  Providers will submit request for Prior Authorization to DXC Technology.

** Please Note: The contact person and number provided should not be utilized for making appointments. Members that are enrolled with one of the Healthy Louisiana plans should contact Healthy Louisiana via the information below:

https://www.myplan.healthy.la.gov/en

Phone

Monday through Friday from 8:00 a.m. to 5:00 p.m. Call 1-855-229-6848.

For hearing impaired (TTY) please call

1-855-526-3346.

Mail

Healthy Louisiana

P.O. Box 1097

Atlanta, GA 30301-9913

Fax

1-888-858-3875

CONTACT:

Sharetha Brown

225/219-2555

Pre-Natal Care

HOW TO ACCESS:

Physicians or Healthcare Professional

ELIGIBILITY:

Female Medicaid recipients of child bearing age.

COVERED SERVICES:

Office visits.

Lab and radiology services.

COMMENTS:

** Please Note: The contact person and number provided should not be utilized for making appointments. Members that are enrolled with one of the Healthy Louisiana plans should contact Healthy Louisiana via the information below:

https://www.myplan.healthy.la.gov/en

Phone

Monday through Friday from 8:00 a.m. to 5:00 p.m. Call 1-855-229-6848.

For hearing impaired (TTY) please call

1-855-526-3346.

Mail

Healthy Louisiana

P.O. Box 1097

Atlanta, GA 30301-9913

Fax

1-888-858-3875

CONTACT:

Sharetha Brown

225/219-2555

Psychiatric Hospital Care

HOW TO ACCESS:

Physician/Hospital

ELIGIBILITY:

All Medicaid recipients.

Medically Needy (Type Case 20 & 21) under age 22 are not eligible for Inpatient Psychiatric Services.

COVERED SERVICES:

Inpatient hospital care needed for the treatment of an illness or injury which can only be provided safely & adequately in a hospital setting.

Includes those basic services that a hospital is expected to provide.


CONTACT:

Providers: ProviderRelations@la.gov 

Members: Healthy@la.gov

Psychological Evaluation and Therapy Services

See Early Steps; EPSDT Psychological and Behavioral Services; FQHC; Rural Health Clinics; Therapy Services-School Boards

Rehabilitation Clinic Services

HOW TO ACCESS:
Physician

ELIGIBILITY:

Medicaid recipients 0 through 20 years of age

COVERED SERVICES:

Occupational Therapy, Physical Therapy, Speech, Language and Hearing Therapy

COMMENTS:

All services must be Prior Authorized.

The provider of services will submit the request for Prior Authorization.

CONTACT:

Justin Owens

225/342-6888

Rural Health Clinics

HOW TO ACCESS:

Rural Health Clinic

The American Indian Clinic

ELIGIBILITY:

All Medicaid recipients

COVERED SERVICES:

Professional medical services furnished by physicians, nurse practitioners, physician assistants, nurse midwives, clinical social workers, clinical psychologists, and dentists.

COMMENTS:

There are three components that may be provided: 1) Encounter visits; 2) EPSDT Screening Services; and 3) EPDST Dental, and Adult Denture Services.

CONTACT:

Irma Gauthier
225/342-5691

STD Clinics

HOW TO ACCESS:

OPH Public Health Units

ELIGIBILITY:

All Medicaid recipients.

COVERED SERVICES:

Testing, counseling, and treatment of all sexually transmitted diseases (STD). Confidential HIV testing.

CONTACT:

Public Health Unit directory

Speech Therapy and Language Evaluation and Therapy

See EarlySteps; Therapy Services; Rehabilitation Clinic Services; Hospital-Outpatient Services; Home Health

Therapy Services

HOW TO ACCESS:

Recipients have the choice of services from the following provider types: Home Health; Hospital-Outpatient Services; and Rehabilitation Clinic Services.

ELIGIBILITY:

Medicaid recipients 0 through 20 years of age.

COVERED SERVICES:

• Audiological Services (Available in Rehabilitation Clinic and Hospital-Outpatient settings only.)
• Occupational Therapy
• Physical Therapy
• Speech & Language Therapy

COMMENTS:

Covered services can be provided in the home through Home Health and Rehabilitation Clinics. Services provided by Rehabilitation Clinics can also be provided at the clinic. Services provided through Hospital-Outpatient Services must be provided at the facility/clinic.

Covered services may be provided in addition to services provided by  EarlySteps/EICs or School Boards if prescribed by a physician and Prior  Authorized.

All medically necessary services must be prescribed by a physician and Prior Authorization is required. The provider of services will submit requests for Prior Authorization.

CONTACT:

Justin Owens
225/342-6888

HOW TO ACCESS:

EPSDT Health Services-Early Intervention Centers (EIC) or EarlySteps Program

ELIGIBILITY:

Medicaid recipients under 3 years of age.

COVERED SERVICES:

• Audiological Services
• Occupational Therapy
• Physical Therapy
• Speech & Language Therapy
• Psychological Therapy

COMMENTS:

All EPSDT Health Services through EICs amd EarlySteps must be included in the infant/toddler's Individualized Family Service Plan (IFSP). If services are provided by an EIC or EarlySteps, Prior Authorization requirements are met through inclusion of services on the IFSP.

CONTACT:

Brenda Sharp
225/342-8932

HOW TO ACCESS:

EPSDT Health Services-Local Education Agencies (LEA) e.g. School Boards

ELIGIBILITY:

Medicaid recipients 3 through 20 years of age.

COVERED SERVICES:

• Behavioral Health Services
• Applied Behavior Analyst Therapy (ABA)
• Occupational, Physical, Speech and Respiratory Therapy
• Optometry Services
• Personal Care Services (PCS)
• Physician/Nursing Services
• Transportation

 
COMMENTS:

• Services are performed by the Local Education Agencies (LEA).
• EPSDT health services on the Medicaid approved Periodicity Table may be reimbursed when provided by a licensed practitioner within the scope of their practice. All other health services must be included in a completed authorizing document pursuant to 34 C.F.R. § 104.36:
  • Individualized Education Plan (lEP);
  • Section 504 Accommodation Plan;
  • Individualized Health Care Plan; or
  • Any other medically necessary written plan of care.

CONTACT:

Anissa Young-Ned
225/342-6885

Transportation

Non-Emergency Medical Transportation

HOW TO ACCESS:

All Medicaid beneficiaries, who are eligible for transportation services and DO NOT receive transportation services through a managed care plan, should contact Verida to schedule a ride.

Beneficiaries may reach the Fee-For-Service broker, Verida, at 1 (855)325-7626.

Medicaid beneficiaries who DO receive transportation services from a managed care plan should contact the call centers as follows:

ELIGIBILITY:

Medicaid covered transportation is available to Medicaid beneficiaries when:

• The beneficiary is enrolled in a Medicaid benefit program that explicitly includes transportation services; and
• The beneficiary or their representative has stated that they have no other means of transportation.

COVERED SERVICES:

Transportation to and/or from Medicaid covered services, including carved-out services, or value added benefits (VAB) when no other means of transportation is available.

Beginning January 1, 2023, Medicaid will only reimburse for a beneficiary’s transportation services to a Fee-For-Service (FFS) provider or a managed care provider if that provider has enrolled through the Medicaid Provider Enrollment.

LDH granted all NEMT providers an extension for enrollment in the Medicaid Provider Portal.  LDH requires all NEMT providers to enroll in the Medicaid Provider Portal no later than June 30, 2023.

Attendants

An attendant shall be required when the beneficiary is under the age of 17.

The attendant must:

• Be a parent, legal guardian, or responsible person designated by the parent/legal guardian; and
• Be able to authorize medical treatment and care for the beneficiary.

Attendants may not:

• Be under the age of 17; or
• Be a Medicaid provider or employee of a Medicaid provider that is providing services to the beneficiary being transported, except for employees of a mental health facility in the event an beneficiary has been identified as being a danger to themselves or others or at risk for elopement.
• Be a transportation provider or an employee of a transportation provider.

If a child is to be transported, either as the beneficiary or an additional passenger, the parent or guardian of the child is responsible for providing an appropriate child passenger restraint system as outlined by La. R.S. 32:295.

Meals and Lodging

Eligible expenses include the following when necessary to ensure the delivery of medically necessary services:

• Transportation for the beneficiary and one attendant; and
• Meals, lodging, and other related travel expenses for the beneficiary and one attendant when long distance travel is required. Long distance is defined as when the total travel time, including the duration of the appointment plus the travel to and from the appointment, exceeds 12 hours

Medicaid covers meals and lodging for trips that are not otherwise covered in the inpatient per diem, primary insurance, or other payer source.

COMMENTS:

Medicaid beneficiaries should contact transportation broker call centers at least 48 hours prior to the requested transportation services.

With the exception of urgent transportation requests and discharges from inpatient facilities, when requesting transportation services, the beneficiary’s and healthcare providers should schedule all services a minimum of 48 hours prior to the requested appointment.  The 48-hour minimum does not include non-business days. However, the MCO and/or transportation broker must make a reasonable attempt to schedule the trip with less than 48 hours’ notice.

MCOs shall make every effort to schedule urgent transportation requests and may not deny a request based solely on the appointment being scheduled less than 48 hours in advance.

• Urgent transportation refers to a request for transportation made by a healthcare provider for a medical service, which does not warrant emergency transport but cannot be postponed.
• Urgent transportation shall include chemotherapy, radiation, dialysis, OTP, or other necessary medical care that cannot be rescheduled to a later time.

All non-emergency out-of-state transportation must be prior approved by the MCO or transportation broker. The MCO may approve transportation to out-of-state medical care only if the beneficiary has been granted approval to receive medical treatment out of state when it is the nearest option available. Coordination of approvals may take longer than 48 hours.

Non-Emergency Ambulance Transportation (NEAT)

HOW TO ACCESS:

All Medicaid beneficiaries, who are eligible for transportation services and DO NOT receive transportation services through a managed care plan, should contact Verida to schedule a ride. 

Beneficiaries may reach the Fee-For-Service broker, Verida, at (225) 726-2800.

Medicaid beneficiaries who DO receive transportation services from a managed care plan should contact the call centers as follows:

ELIGIBILITY:

Medicaid covered transportation is available to Medicaid beneficiaries when:

• The beneficiary is enrolled in a Medicaid benefit program that explicitly includes transportation services; and
• The beneficiary or their representative has stated that they have no other means of transportation.

GROUND AMBULANCE COVERED SERVICES:

NEAT is provided to a Medicaid beneficiary to and/or from a Medicaid covered service, including carved out services or value-added benefits (VAB) by ground or air ambulance when the beneficiary’s condition is such that use of any other method of transportation is contraindicated or would make the beneficiary susceptible to injury. The nature of the trip is not an emergency, but the beneficiary requires the use of an ambulance.

Beginning January 1, 2023, Medicaid will only reimburse for a beneficiary’s transportation services to a FFS provider or a managed care provider if that provider has enrolled through the Medicaid Provider Enrollment.  All ambulance providers are required to enroll in the Medicaid Provider Portal no later than December 31, 2022.

Please note that ALL NEAT trips will require a completed, valid Certification of Ambulance Transportation (CAT). The beneficiary’s treating physician, a registered nurse, the director of nursing at a nursing facility, a nurse practitioner, a physician assistant, or a clinical nurse specialist must certify on the Certification of Ambulance Transportation (CAT) that the transport is medically necessary and describe the medical condition, which necessitates ambulance services. 

The MCO, transportation broker, and/or the ambulance provider shall verify, prior to scheduling, beneficiary eligibility, that the originating or destination address belongs to a medical facility, and that a completed Certification of Ambulance Transportation form for the date of service is obtained, reviewed, and accepted by the MCO, transportation broker, and/or the ambulance provider prior to transport.

Attendants
An attendant shall be required when the beneficiary is under the age of 17.

The attendant must:

• Be a parent, legal guardian, or responsible person designated by the parent/legal guardian; and
• Be able to authorize medical treatment and care for the beneficiary.

Attendants may not:

• Be under the age of 17; or
• Be a Medicaid provider or employee of a Medicaid provider that is providing services to the beneficiary being transported, except for employees of a mental health facility in the event an beneficiary has been identified as being a danger to themselves or others or at risk for elopement.

Comments:

Medicaid beneficiaries should contact the broker’s call centers at least 48 hours prior to the requested transportation services.

With the exception of urgent transportation requests and discharges from inpatient facilities, when requesting transportation services, the beneficiary’s and healthcare providers should schedule all services a minimum of 48 hours prior to the requested appointment.  The 48-hour minimum does not include non-business days. However, the MCO and/or transportation broker must make a reasonable attempt to schedule the trip with less than 48 hours’ notice. 

MCOs shall make every effort to schedule urgent transportation requests and may not deny a request based solely on the appointment being scheduled less than 48 hours in advance.

Urgent transportation refers to a request for transportation made by a healthcare provider for a medical service, which does not warrant emergency transport but cannot be postponed. 

Urgent transportation shall include chemotherapy, radiation, dialysis, OTP, or other necessary medical care that cannot be rescheduled to a later time.

All non-emergency out-of-state transportation must be prior approved by the MCO or transportation broker. The MCO may approve transportation to out-of-state medical care only if the beneficiary has been granted approval to receive medical treatment out of state when it is the nearest option available. Coordination of approvals may take longer than 48 hours.

Nursing Facility Ambulance Transportation 

Nursing facilities are required to provide medically necessary transportation services for Medicaid beneficiary residing in their facilities.

Any nursing facility beneficiary needing non-emergency, non-ambulance transportation services are the financial responsibility of the nursing facility. NEAT services provided to a nursing facility beneficiary must include the Certification of Ambulance Transportation, in accordance with the Coverage Requirements section, to be reimbursable by the MCO and/or transportation broker; otherwise, the nursing facility shall be responsible for reimbursement for such services.

Air Ambulance: 

Air ambulances may be used for emergency and non-emergency ambulance transportation when medically necessary.

All air ambulance services must comply with state laws and regulations governing the personnel certifications of the emergency medical technicians, registered nurses, respiratory care technicians, physicians, and pilots as administered by the appropriate agency of competent jurisdiction.

The MCO shall cover air ambulance services only if:

• Speedy admission of the beneficiary is essential and the point of pick-up of the beneficiary is inaccessible by a land vehicle; or
• Great distances or other obstacles are involved in getting the beneficiary to the nearest hospital with appropriate services.

If both land and air ambulance transport are necessary during the same trip, the MCO shall reimburse each type of provider separately according to regulations for that type of provider.

The MCO and/or transportation broker may not require prior review or authorization for emergency air ambulance transportation, both rotary and fixed wing.

The MCO and/or transportation broker may require prior review or authorization for non-emergency air ambulance transportation, both rotary and fixed wing.

Emergency Ambulance Transportation (EMT)

HOW TO ACCESS:

Emergency ambulance providers, Dial 911 for all situations requiring emergency medical services.

ELIGIBILITY:

Medicaid covered transportation is available to Medicaid beneficiaries when:

• The beneficiary is enrolled in a Medicaid benefit program that explicitly includes emergency transportation services

COVERED SERVICES:

Emergency ambulance transportation is provided for a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in any of the following:

• Placing the health of the beneficiary (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy;
• Serious impairment to bodily functions; or
• Serious dysfunction of any bodily organ or part.

A beneficiary may also require emergency ambulance transportation if he or she is psychiatrically unmanageable or needs restraint.

Beginning January 1, 2023, Medicaid will only reimburse for a beneficiary's transportation services to a FFS provider and/or managed care provider if that provider has enrolled through the Medicaid Provider Enrollment Portal

CONTACT:

All Transportation inquiries (both NEMT, NEAT, and EMT)

Email: MedicaidTransportation@la.gov

Phone Number: 225/342-9566 or 225/333-7473

Related Info

• Certification of Ambulance Transportation form
• Medical Transportation Provider Resources
• Non-Emergency Ambulance Transportation Frequently Asked Questions
• Ambulance Standards
• Emergency Medical Services

Tuberculosis Clinics

HOW TO ACCESS:

Office of Public Health Local Health Unit

ELIGIBILITY:

All Medicaid recipients

COVERED SERVICES:

Treatment and disease management services including physician visits, medications, and x-rays.

CONTACT:

TB Control Directory found at:

TB Control Directory

X-Ray Services

HOW TO ACCESS:

Physician

ELIGIBILITY:

All Medicaid recipients.

COVERED SERVICES:

Most diagnostic testing and radiological services ordered by the attending or consulting physician.

Portable (mobile) x-rays are covered only for recipients who are unable to leave their place of residence without special transportation or assistance to obtain physician ordered x-rays.

COMMENTS:

All requests for any radiology services requiring prior approval are initiated by the ordering physician. Recipients may follow up with the ordering physician for the status of any ordered radiology service.

** Please Note: The contact person and number provided should not be utilized for making appointments. Members that are enrolled with one of the Healthy Louisiana plans should contact Healthy Louisiana via the information below:

https://www.myplan.healthy.la.gov/en

Phone

Monday through Friday from 8:00 a.m. to 5:00 p.m. Call 1-855-229-6848.

For hearing impaired (TTY) please call

1-855-526-3346.

Mail

Healthy Louisiana

P.O. Box 1097

Atlanta, GA 30301-9913

Fax

1-888-858-3875

CONTACT:

Sharetha Brown       

225/219-2555

Children's Choice Waiver

ELIGIBILITY:

Medicaid recipients must be in the Children's Choice Waiver.

There is a Request for Services Registry (RFSR) for those requesting waiver services. To get on the RFSR, call the Office for Citizens with Developmental Disabilities District/Authority/Local Regional Office.

COVERED SERVICES:

Coordination of Medicaid and other services.  The Support Coordinator (Case Manager) helps to identify needs, access services and coordinate care. Services available through the Waiver are identified in the waiver section.

COMMENTS:

Support Coordination services must be prior authorized by LDH, Office for Citizens with Developmental Disabilities, Waiver Supports and Services.

The Support Coordination Agency will submit requests for the Prior Authorization.

CONTACT:

Office for Citizens with Developmental Disabilities (OCDD) Waiver Supports and Services: 1-866-783-5553

Complaint Line: 1-800-660-0488

Community Choice Waiver

HOW TO ACCESS:

Office of Aging and Adult Services (OAAS)

1-866-758-5035

Participants call

1-866-758-5035 or 225-219-0643

ELIGIBILITY:

Medicaid recipients must be in the Community Choices Waiver (CCW).

There is a Request for Services Registry (RFSR) for those requesting CCW waiver services. Contact Louisiana Options in Long Term Care at 1-877-456-1146.

COVERED SERVICES:

Coordination of Medicaid and other services.  The Support Coordinator (Case Manager) helps to identify needs, access services and coordinate care.

COMMENTS:

Services must be prior authorized by LDH, Office for Aging and Adult Services (OAAS). The provider will submit requests for the Prior Authorization.

CONTACT:

Office for Aging and Adult Services

1-866-758-5035

EPSDT Targeted Populations

HOW TO ACCESS:

SRI Call Toll-Free 1-800-364-7828, Must be on the DD Request for Services Registry

ELIGIBILITY:

Must be Medicaid eligible and on the DD waiver Request for Services Registry prior to receipt of case management services; or any Medicaid recipient 3 through 20 years of age for whom support coordination is medically necessary (Call SRI at 1-800-364-7828).

To get on the Request for Services Registry, call the Office for Citizens with Developmental Disabilities District/Authority/Local Regional Office.

COVERED SERVICES:

Coordination of Medicaid and other services. The Support Coordinator (Case Manager) helps to identify needs, access services and coordinate care.

COMMENTS:

Support coordination services must be prior authorized by LDH, BHSF, and the Medicaid Program Support and Waivers Section. The Support Coordination Agency will submit requests for the Prior Authorization to SRI.

For other EPSDT services, see that portion of the Medicaid Services chart.

RESOURCES FOR SUPPORT COORDINATION AGENCIES:

• Case Management Manual
• Targeted Case Management Rule
• Regulations
  • LAC 48:I., Chapter 49 Case Management Licensing Standards
• Case Management Provider Enrollment Packet (PT 45)
• Case Management License Application

CONTACT:

SRI  1-800-364-7828

Infants and Toddlers

HOW TO ACCESS:

Office for Citizens with Devlopmental Disabilities (OCDD)

1-866-783-5553

ELIGIBILITY:

Medicaid recipients must be 0 to 3 years of age and have a developmental delay or an established medical condition and eligible for the EarlySteps system.

COVERED SERVICES:

Coordination of Medicaid and other services. The Support Coordinator (Case Manager) helps to identify needs, access services and coordinate care in EarlySteps.

COMMENTS:

Services must be authorized by EarlySteps. Authorizations are approved through the Individualized Family Service Plan (IFSP) process.

CONTACT:

Brenda Sharp
225/342-8853

New Opportunities Waiver (NOW)

ELIGIBILITY:

Medicaid beneficiaries must be in the New Opportunities Waiver.

There is a Request for Services Registry (RFSR) for those requesting waiver services. To get on the RFSR, call the Office for Citizens with Developmental Disabilities District/Authority/Local Regional Office.

COVERED SERVICES:

Coordination of Medicaid and other services. The Support Coordinator (Case Manager) helps to identify needs, access services and coordinate care.

Services available through the Waiver are identified in the waiver section.

COMMENTS:

Support Coordination services must be prior authorized by LDH, Office for Citizens with Developmental Disabilities, Waiver Supports and Services.

The Support Coordination Agency will submit requests for the Prior Authorization *Call the Office for Citizens with Developmental Disabilities Districts/Authorities/Local Regional Offices for status on the Request for Services Registry.

Office for Citizens with Developmental Disabilities (OCDD) Waiver Supports and Services: 1-866-783-5553

Complaint Line: 1-800-660-0488

Residential Options Waiver (ROW)

 ELIGIBILITY:

Medicaid beneficiaries must be in the Residential Options Waiver.

There is a Request for Services Registry (RFSR) for those requesting waiver services. To get on the RFSR, call the Office for Citizens with Developmental Disabilities District/Authority Local Regional Office.

COVERED SERVICES:

Coordination of Medicaid and other services. The Support Coordinator (Case Manager) helps to identify needs, access services and coordinate care.

Services available through the Waiver are identified in the waiver section of this document.

COMMENTS:

Support Coordination services must be prior authorized by LDH, Office for Citizens with Developmental Disabilities, Waiver Supports and Services.

The Support Coordination Agency will submit requests for the Prior Authorization.

CONTACT:

Office for Citizens with Developmental Disabilities (OCDD): 1-866-783-5553

Complaint Line: 1-800-660-0488

Supports Waiver

ELIGIBILITY:

Medicaid beneficiaries must be in the Supports Waiver.

There is a Request for Services Registry (RFSR) for those requesting waiver services. To get on the RFSR, call the Office for Citizens with Developmental Disabilities District/Authority/Local Regional Office.

COVERED SERVICES:

Coordination of Medicaid and other services. The Support Coordinator (Case Manager) helps to identify needs, access services and coordinate care.

Services available through the Waiver are identified in the waiver section.

COMMENTS:

Support Coordination services must be prior authorized by LDH, Office for Citizens with Developmental Disabilities, Waiver Supports and Services.

The Support Coordination Agency will submit requests for the Prior Authorization.

Office for Citizens with Developmental Disabilities (OCDD) Waiver Supports and Services: 1-866-783-5553

Complaint Line: 1-800-660-0488

Adult Day Health Care (ADHC)

Adult Day Health Care (ADHC) Waiver Fact Sheet

Children's Choice

HOW TO ACCESS:

Individuals who have a need for services should contact their Local Governing Entity (LGE) in order to go through the eligibility determination process.  Once a person is eligible for OCDD services, they may ask to be placed on the Developmental Disability Request for Services Registry (RFSR).

Home and community-based waiver opportunities are provided based on the individual’s prioritized need for support, which is identified in their RFSR Screening for Urgency of Need.  Individuals with emergent and urgent need for support will have priority.

For more information on this process, please contact your local Human Services District/Authority.  For contact information, click here.

For more information about the Children's Choice Waiver, click here.

ELIGIBILITY:

Meet Louisiana Medicaid eligibility AND

Meet the Louisiana definition for developmental disability which manifested prior to the age of 22 (Revised Statute 28:451.2, Paragraph (11)) AND

Have an OCDD Statement of Approval AND

Meet My Place eligibility if age 0-3 AND

Meet Intermediate Care Facility-Intellectual Disability (ICF-ID) Level of Care Criteria AND

Are 0 through 20 years of age.

COVERED SERVICES:

• Support Coordination
• Family Support
• Crisis Support
• Center-Based Respite
• Family Training
• Environmental Accessibility Adaptations
• Specialized Medical Equipment
• Permanent Supportive housing Stabilization and Transition
• Therapy services: Aquatic Therapy, Art Therapy, Music Therapy, Hippo-Therapy/Therapeutic Horseback Riding, Sensory Integration
• Financial Management Services for Self-Direction

*Individuals under the age of 21 years of age must access Early and Periodic Screening, Diagnostic and Treatment Personal Care Services (EPSDT-PCS).

COMMENTS:

This is a capped waiver and is designed for maximum flexibility.

Youth who reach the age of 18 and want to work may choose to transition to a Supports Waiver as long as they remain eligible for waiver services.

Youth who continue in the CC Waiver beyond age 18 will age out of CC Waiver when they reach their 21^st birthday.  They will transition to the most appropriate waiver that meets their needs as long as they remain eligible for waiver services.

This program is not intended to provide 24 hours a day of support.  For additional information regarding this program click here.

* Call the Office for Citizens with Developmental Disabilities or local Districts/Authorities for status on the Request for Services Registry.

CONTACT:

Tracy Joshua-Guy (225) 342-0943

Community Choices Waiver

Community Choices Waiver Fact Sheet

New Opportunities Waiver

HOW TO ACCESS:

Individuals who have a need for services should contact their Local Governing Entity (LGE) in order to go through the eligibility determination process.  Once a person is eligible for OCDD services, they may ask to be placed on the Developmental Disability Request for Services Registry (RFSR).

Home and community-based waiver opportunities are provided based on the individual’s prioritized need for support, which is identified in their RFSR Screening for Urgency of Need.  Individuals with emergent and urgent need for support will have priority.

For more information on this process, please contact your local Human Services District/Authority. For contact information, click here.

For more information about New Opportunities Waiver, click here.

ELIGIBILITY:

• Meet Louisiana Medicaid eligibility AND
• Meet the Louisiana definition for developmental disability which manifested prior to the age of 22 (Revised Statute 28:451.2, Paragraph (11)) AND
• Have an OCDD Statement of Approval AND
• Meet Intermediate Care Facility-Intellectual Disability (ICF-ID) Level of Care Criteria AND
• Are 3 years of age or older AND
• Whose needs cannot be met in another OCDD Waiver.

COVERED SERVICES:

• Individual and Family Support (IFS) for Day, Night, Shared
• Center-Based Respite
• Community Life Engagement Development
• Environmental Accessibility Adaptations
• Specialized Medical Equipment and Supplies
• Supported Independent Living
• Substitute Family Care
• Day Habiliatation/Community Life Engagement and Transportation
• Supported Employment (individual or group) and Transportation
• Skilled Nursing
• Prevocational/Community Career Planning and Transportation
• Personal Emergency Response System (PERS)
• Permanent Supportive housing Stabilization and Transition
• One time transitional services
• Monitored In Home Care Giving (MIHC)
• Adult Companion Care
• Professional Services
• Expanded Dental Services for Adult Waiver Beneficiaries
• Financial Management Services for Self-Direction

*Individuals under the age of 21 years of age must access Early and Periodic Screening, Diagnostic and Treatment Personal Care Services (EPSDT-PCS).

*Individuals will receive Support Coordination services via state plan.

COMMENTS:

The NOW is intended to provide specific activity-focused services rather than continuous custodial care.  For additional information regarding this program click here.

CONTACT:

Ed Harris  (225) 342-8537

Residential Options Waiver (ROW)

HOW TO ACCESS:

Individuals who have a need for services should contact their Local Governing Entity (LGE) in order to go through the eligibility determination process.  Once a person is eligible for OCDD services, they may ask to be placed on the Developmental Disability Request for Services Registry (RFSR).

Home and community-based waiver opportunities are provided based on the individual’s prioritized need for support, which is identified in their RFSR Screening for Urgency of Need.  Individuals with emergent and urgent need for support will have priority.

For more information on this process, please contact your local Human Services District/Authority.  For contact information, click here.

For mor information about the Residential Options Waiver, click here.

ELIGIBILITY:

Meet Louisiana Medicaid eligibility AND

Meet the Louisiana definition for developmental disability which manifested prior to the age of 22 (Revised Statute 28:451.2, Paragraph (12)) AND

Have an OCDD Statement of Approval AND

Meet Intermediate Care Facility-Intellectual Disability (ICF-ID) Level of Care Criteria AND

Meet one of four ROW priority group criteria.

COVERED SERVICES:

• Support Coordination
• Community Living Supports
• Host Home Services
• Companion Care Services
• Shared Living
• Adult Day Health Care
• Respite-Out of Home
• Personal Emergency Response System (PERS)
• One Time Transitional Services
• Environmental Accessibility Adaptations
• Monitored In Home Caregiving (MIHC)
• Specialized Medical Equipment and Supplies
• Community Life Engagement Development
• Professional Services
• Nursing Services
• Supported Employment (Individual or group) and transportation
• Prevocational/Community Career Planning and Transportation
• Day Habilitation/Community Life Engagement and Transportation
• Permanent Supportive housing Stabilization and Transition
• Expanded Dental Services for Adult Waiver Beneficiaries
• Financial Management Services for Self-Direction

*Individuals under the age of 21 years of age must access Early and Periodic Screening, Diagnostic and Treatment Personal Care Services (EPSDT-PCS).

COMMENTS:

This waiver is a capped waiver where the person’s individual and annual budget are based upon the person’s assessed support needs.

An Inventory for Client and Agency Planning (ICAP) assessment determines the supports needs. Beneficiaries may choose to self-direct all or part of his/her Community Living Supports. This program is not intended to provide 24 hours a day one-to-one support. For additional information regarding this program click here.

CONTACT:

Denise Boyd (225) 342-5647

Supports Waiver

HOW TO ACCESS:

Individuals who have a need for services should contact their Local Governing Entity (LGE) in order to go through the eligibility determination process.  Once a person is eligible for OCDD services, they may ask to be placed on the Developmental Disability Request for Services Registry (RFSR).

Home and community-based waiver opportunities are provided based on the individual’s prioritized need for support, which is identified in their RFSR Screening for Urgency of Need.  Individuals with emergent and urgent need for support will have priority.

For more information on this process, please contact your local Human Services District/Authority.  For contact information, click here.

For more information about the Supports Waiver, click here.

ELIGIBILITY:

Meet Louisiana Medicaid eligibility AND

Meet the Louisiana definition for developmental disability which manifested prior to the age of 22 (Revised Statute 28:451.2, Paragraph (11)) AND

Have an OCDD Statement of Approval AND

Meet Intermediate Care Facility-Intellectual Disability (ICF-ID) Level of Care Criteria AND

Are 18 years of age or older.

COVERED SERVICES:

• Support Coordination
• Supported Employment (individual or group) and transportation
• Day Habilitation/Community Life Engagement and Transportation
• Prevocational/Community Career Planning and transportation
• Habilitation
• Respite (center-based or in home)
• Permanent Supportive Housing Stabilization and Transition
• Personal Emergency Response System (PERS)
• Expanded Dental Services for Adult Waiver Beneficiaries
• Community Life Engagement Development
• Specialized Medical Equipment and Supplies

*Individuals who are 18-21 years of age may access Early Periodic Screening, Diagnostic and Treatment Personal Care Services (EPSDT-PCS).

*Individuals 21 years of age or older who receive SW may also receive Long Term-Personal Care Services (LT-PCS).

COMMENTS:
This program is not intended to provide 24 hours a day of support.  For additional information regarding this program click here.

CONTACT:

Rosemary Morales (225) 342-0095