Health Plan Advisories

HPA 21-03: Bipartisan Budget Act of 2018 and Changes to Medicaid Provisions for “Pay and Chase” Passed April 2019 – Third Party Liability in Medicaid and CHIP

HPA 21-02: Developmental Screening, Autism Screening, and Perinatal Depression Screenings

HPA 21-01: Donor Human Milk

HPA 20-25: EPSDT Periodicity Schedule

HPA 20-24: MCO Preparation – 2021 Healthcare Common Procedure Coding System Update

HPA 20-23 ESRD Facilities and Independent Laboratory – Non-Routine Laboratory Services (Retired. Refer to Medicaid Services Manual, End Stage Renal Disease.)

HPA 20-22: Inpatient Concurrent Care (Retired. Refer to MCO Manual.)

HPA 20-21: Obstetric Ultrasounds by Maternal Fetal Medicine Specialists (Retired. Refer to MCO Manual.)

HPA 20-20 Dental Benefit Program Manager Update (Retired)

HPA 20-19 Changes to Durable Medical Equipment, Pediatric Day Health Care, Home Health, Rehabilitation and Personal Care Services due to Hurricane Delta

HPA 20-18 Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Personal Care Services (PCS) Update for Hurricane Laura

HPA 20-17 Changes to Durable Medical Equipment, Pediatric Day Health Care, Home Health, Rehabilitation and Personal Care Services due to Hurricane Laura (Revised September 1, 2020)

HPA 20-16 Class Action Lawsuit: AJ v. LDH (Retired. Refer to MCO Manual.)

HPA 20-15 Long-Term Electroencephalography (EEG) Setup and Monitoring (Retired)  

HPA 20-14 Tobacco Cessation for Pregnant Women  (Retired)

HPA 20-13 COVID-19 Update for PDHC Facilities

HPA 20-12 Telehealth Marketing and Member Education

HPA 20-11 Revised 96-A Hysterectomy Acknowledgment Form (Retired. Refer to MCO Manual.)

HPA 20-10 EPSDT Personal Care Services

HPA 20-9 COVID-19 – SUD Telemedicine/Telehealth (Revised February 25, 2021)

HPA 20-8 COVID-19 – LMHP Telemedicine/Telehealth (Revised February 25, 2021)

HPA 20-7 COVID-19 – MHR Telemedicine/Telehealth (Revised February 25, 2021)

HPA 20-6 Response to COVID-19 (Revised October 21, 2021)

HPA 20-5 PASRR Level II Evaluations: COVID-19 (Revised April 13, 2020)

HPA 20-4 2020 HCPCS and Physician-Administered Drug Reimbursement Updates

HPA 20-3 Reimbursement of Opioid Use Disorder Treatment in Opioid Treatment Programs (Retired)

HPA 20-2 Telemedicine and Telehealth Billing Changes for RHCs and FQHCs (Retired. Refer to Medicaid Services Manual for FQHC/RHC policies. Refer to MCO Manual for telemedicine policies.)

HPA 20-1 LSU Enhanced Professional Service Fees to be Paid Effective 1/1/2020 (Retired. Refer to MCO Manual.)

HPA 19-18 2020 Healthcare Common Procedure Coding System (HCPCS) Update (Retired)

HPA 19-17 LPC and LMFT Reimbursement in FQHCs and RHCs (Retired)

HPA 19-16 Hospice Fee Schedule Federal Fiscal Year 2020

HPA 19-15 Electronic Visit Verification for EPSDT Personal Care Services (Retired. Refer to MCO Manual.)

HPA 19-14 Severe Combined Immunodeficiency (SCID) Testing (Retired. Refer to MCO Manual.)

HPA 19-13 EPSDT PCS Rate Change

HPA 19-12 Changes to Durable Medical Equipment, Home Health, Rehabilitation and Personal Care Services and Pharmacy Due to Tropical Storm Barry (Retired)

HPA 19-11 Telemedicine/Telehealth Billing Changes (Retired. Refer to MCO Manual.)

HPA 19-10 Definitive Drug Testing (Retired. Refer to MCO Manual.)

HPA 19-9 CLIA Number Information (Retired. Refer to MCO Manual.)

HPA 19-8 Extended Home Health TV Modifier Use (Retired)

HPA 19-7 Behavioral Health Alternate Payment Methodology in FQHCs and RHCs (Retired)

HPA 19-6 Applied Behavior Analysis Fee Schedule (Retired)

HPA 19-5 Member Reassignment Policy Core Elements (Retired. Refer to MCO Manual.)

HPA 19-4 Breast Pump Coverage – Attestation and Equipment Requirements (Retired)

HPA 19-3 2019 HCPCS and Physician-Administered Drug Reimbursement Updates (Retired)

HPA 19-2 Pharmacy Copay Threshold (Retired. Refer to MCO Manual.)

HPA 19-1 2019 Healthcare Common Procedure Coding System (HCPCS) Update (Retired)

HPA 18-25 New Medicaid Policy: Non-Invasive Prenatal Testing  (Retired. Refer to MCO Manual.)

HPA 18-24 Immunization Coverage Update – Hepatitis B Adult 2 Dose Vaccine (Retired)

HPA 18-23 Updated Codes for Applied Behavior Analysis (ABA) Services (Retired) 

HPA 18-22 Preparation – 2019 Healthcare Common Procedure Coding System (HCPCS) Update (Retired)

HPA 18-21 Preventive Medicine Visits for Women (Retired)

HPA 18-20 Hospice Fee Schedule FFY19 (Retired)

HPA 18-19: Reimbursement for Lynch Syndrome and Familial Adenomatous Polyposis Genetic Testing (Retired. Refer to MCO Manual.)

HPA 18-18: Reimbursement for Screening and Diagnostic Mammographies for FQHC and RHC Providers (Retired)

HPA 18-17: Separate Reimbursement for Long-Acting Reversible Contraceptives in FQHCs and RHCs (Retired)

HPA 18-16: Coverage of Electric Breast Pumps (Retired)

HPA 18-15: Coverage of Continuous Glucose Monitoring Devices (Retired)

HPA 18-14: Physician Administered Drugs Reimbursement Changes (Retired. Refer to MCO Manual.)

HPA 18-13: OPH – “Family Planning Clinic” Fee Schedule  (Retired)

HPA 18-12: Emergency Contraceptives (Retired. Refer to MCO Manual.)

HPA 18-11: Managed Care Linkage for Long Term Care Members (Retired. Refer to MCO Manual.)

HPA 18-10: Physician Administered Drugs (Retired)

HPA 18-9: Common Observation Policy (Retired. Refer to MCO Manual.)

HPA 18-8: Portable Oxygen Coverage and Reimbursement (Retired)

HPA 18-7: Rehabilitation Therapy Services (Retired. Refer to MCO Manual.)

HPA 18-6: 2018 Louisiana Medicaid EPSDT Periodicity Schedule (Retired. Refer to MCO Manual.)

HPA 18-5: Prior Authorization of Non-Emergency Ambulance Services (Retired. Refer to MCO Manual.)

HPA 18-4: Ambulance Non-Covered Services Modifiers (Retired. Refer to MCO Manual.)

HPA 18-3: Proton Beam Radiation Therapy -- Age Criteria Revised (Retired. Refer to MCO Manual.)

HPA 18-2: 2018 HCPCS and Fee Schedule Updates (Retired)

HPA 18-1: 2018 Healthcare Common Procedure Coding System (HCPCS) Update #2 (Retired)

HPA 17-23: Drug Utilization Review (DUR) Program (Retired. Refer to MCO Manual.)

HPA 17-22: Neonatal/Pediatric Critical Care Billing (Retired. Refer to MCO Manual.)

HPA 17-21: Clarification of Louisiana Medicaid Policy Regarding Pediatric Moderate Conscious Sedation (Retired)

HPA 17-20: 2018 Healthcare Common Procedure Coding System (HCPCS) Update Preparation (Retired)

HPA 17-19: Applied Behavior Analysis Services (Retired)

HPA 17-18: Changes to Pharmacy Services due to Tropical Storm Nate (Retired effective Oct. 9, 2017 at 11:59 p.m.)

HPA 17-17: Changes to Durable Medical Equipment due to Tropical Storm Nate (Retired effective Oct. 9, 2017 at 11:59 p.m.)

HPA 17-16: Medical Transportation Requirements and Post-Authorization for Emergency Air Ambulance Transportation Services (Revised October 10, 2017)

HPA 17-15: Guidance for Medicare Advantage Participation

HPA 17-14: Influenza Virus Vaccine (CPT Code 90686) Age Revision (Retired)

HPA 17-13: Hospice Rates for Federal Fiscal Year 2017 (Retired)

HPA 17-12: TPL Scope of Coverage Response on MCO Provider Portals (Retired. Refer to MCO Manual.)

HPA 17-11: Approval Guidelines for Lien Settlements Equal to or Greater than $25,000 (Retired. Refer to MCO Manual.)

HPA 17-10: Louisiana Medicaid Fee Schedule Update Change (Retired)

HPA 17-9: Clinical Laboratory Services - Fee Reimbursement (Retired)

HPA 17-8: Single PDL for Selected Therapeutic Classes (Retired)

HPA 17-7: Updated Opioid Prescription Policy (Retired)

HPA 17-6: Common Preferred Drug List (PDL) (Retired)

HPA 17-5: 2017 Healthcare Common Procedure Coding System (HCPCS) Update (Retired)

HPA 17-4: 340B Policy - Claim Level Indicators (Retired. Refer to MCO Manual.)

HPA 17-3: Errors in the NCCI Edit File - Physical and Occupational Therapy Codes (Retired)

HPA 17-2: Errors in the NCCI Edit File - Moderation Sedation Codes (Retired)

HPA 17-1: Post-Payment COB Recoveries from Providers and Liable Third Parties (Retired. Refer to MCO Manual.)

HPA 16-38: Priority Payer Name for Pay and Chase Records (Revised March 17, 2017)

HPA 16-37: 2017 Healthcare Common Procedure Coding System (HCPCS) Update (Retired)

HPA 16-36: VFC Coverage of Human Papilloma Virus (HPV) Vaccine, CPT Code 90651 (Retired)

HPA 16-35: Opioid Edits for Pharmacy Claims (Retired)

HPA 16-34: Inpatient Billing after Outpatient Status (Retired)

HPA 16-33: Papanicolaou Test (Pap Test) Age Criteria (Retired)

HPA 16-32: Billing Immunization Administration Code 90472 (Retired)

HPA 16-31: Retroactive Member Enrollment Claims Processing (Retired. Refer to MCO Manual.) 

HPA 16-30: Global Maternity Procedure Codes (Retired. Refer to MCO Manual.) 

HPA 16-29: Pharmacy copayment exemptions for preventive medications (Retired. Refer to MCO Manual.) 

HPA 16-28: Intranasal Flu Vaccines for 2016-2017 (Retired)

HPA 16-27: Managed Care Organization (MCO) Returned Mail Procedures (Retired. Refer to MCO Manual.) 

HPA 16-26: Preventive Services Added to Fee Schedule as a Result of Medicaid Expansion (Retired)

HPA 16-25: New Breast Reconstruction Post Mastectomy Policy (Retired)

HPA 16-24: New Genetic Testing for Breast and Ovarian Cancer (BRCA) (Retired)

HPA 16-23: Crisis Stabilization-New State Plan Service (Retired)

HPA 16-22: Managing Third Party Liability File Exchanges and Member Updates for Medicaid Enrollees (Retired. Refer to MCO Manual.) 

HPA 16-21: Functional Family Therapy - Child Welfare (FFT-CW) Service Expansion (Retired)

HPA 16-20: Federally Qualified Health Centers Annual Rate Notification Process (Retired)

HPA 16-19: Surgical and Maternity Anesthesia Policy (Retired)

HPA 16-18: Local Pharmacy Claims Dispute Process (Retired)

HPA 16-17: Pay and Chase (Retired. Refer to MCO Manual.) 

HPA 16-16: Early and Periodic Screening, Diagnosis and Treatment Personal Care Services Policy Clarification (Retired)

HPA 16-15: Procedures for Assuring Compliance with Chisholm v Gee (Retired)

HPA 16-14: Mosquito Repellent Coverage as a Pharmacy Benefit (Retired. Refer to MCO Manual.) 

HPA 16-13: Home Health Services: Transition to 15-Minute Units for Home Health Aide Services (Retired)

HPA 16-12: Implementation of New Service Intensity Add-On Rates (Retired)

HPA 16-11: Healthy Louisiana Rebranding (Retired)

HPA 16-10: Pharmacy Provider Fee (Retired)

HPA 16-9: Home Health Services: Transition to 15-Minute Units for Registered Nurse and Licensed Practical Nurse Services (Retired)

HPA 16-8: Batch Pharmacy Encounters Companion Guide and Batch Pharmacy Encounter Processing Edits Update (Retired)

HPA 16-7: 2016 Assistant Surgeon and Assistant at Surgery Covered Procedures (Retired)

HPA 16-6: Identification and Utilization of scope of coverage 27-Major Medical, No Maternity Benefits and scope of coverage 33-HMO, No Maternity Benefits in Third Party Liability (TPL) System and Claims Processing

HPA 16-5: 2016 HCPCS Update for Professional Services, Laboratory, Radiology, ASC and Outpatient Hospital Fee Schedules (Retired)

HPA 16-4: New Hospice Rates Effective January 1, 2016 (Retired)

HPA 16-3: Home Health: 2016 Healthcare Common Procedure Coding System (HCPCS) Update (Retired)

HPA 16-2: 2016 Durable Medical Equipment, Prosthetic, and Orthotics and Supplies (DMEPOS) Healthcare Common Procedure Coding System (HCPCS) Update (Retired)

HPA 16-1: Medicaid Coverage for Freestanding Birthing Centers (Retired)

HPA 15-28: Claims Processing Edits for Provider Taxonomy (Retired)

HPA 15-27: Clarification of Policy Related to Hospital Owned Clinics and Provider Based Billing (Retired)

HPA 15-26: Hospice Rates for Federal Fiscal Year 2016 (Retired)

HPA 15-25: Sterilization Consent Form (Retired)

HPA 15-24: Reimbursement Rate Change Related to HCPCS Code J3490-TH (17 Alpha-Hydroxyprogesterone Caproate) (Retired)

HPA 15-23: Implementation of Act 390 of the 2015 Regular Legislative Session (Retired. Refer to MCO Manual.) 

HPA 15-22: Managed Care Organization Marketing Guidance for Focus Groups

HPA 15-21: Timely Filing Update (Retired)

HPA 15-20: Immunization Procedure Code and Fee Schedule Update (Retired)

HPA 15-19: Coverage and Reimbursement Guidelines for Current Procedural Terminology (CPT) Code 81220 (Retired)

HPA 15-18: Early and Periodic Screening Diagnostic and Treatment-Personal Care Services (Retired)

HPA 15-17: "In Lieu of" Behavioral Health Services (Revised Feb. 23, 2018)

HPA 15-16: Managed Care Organization Claims and Encounter Instructions for Retro Dis-enrolled Members (Retired. Refer to MCO Manual.)

HPA 15-15: Medicaid Behavioral Health Benefits and Services (Retired)

HPA 15-14: Obstetrics Policy Billing Changes (Made obsolete by HPA 16-30) 

HPA 15-13: Medicaid Coverage for Freestanding Birthing Centers (Retired)

HPA 15-12: 2015 Healthcare Common Procedure Coding System (HCPCS) Update (Retired)

HPA 15-11: Transition of Retroactive Reimbursement Functions (Retired. Refer to MCO Manual.) 

HPA 15-10: Shared Plan Member Claims - Reimbursement of Vagus Nerve Stimulator (VNS) (Retired)

HPA 15-9: Change to Fee Schedule for Rotary Wing Ambulance Services (Retired. Refer to MCO Manual.)

HPA 15-8: Early Elective Deliveries Data Receipt and Use by Bayou Health Shared Savings Plans (UHC and CHS) (Retired)

HPA 15-7: Medicaid Recipient Insurance Updates (Retired) 

HPA 15-6: Claims Payment Methodology for LaHIPP Recipients (Retired May 15, 2019)

HPA 15-5: NEMT - Meals and Lodging (Retired)

HPA 15-4: Authorization and Payment of Observation Status (Retired)

HPA 15-3: Healthcare Common Procedure Coding System (HCPCS) Codes Payable to Podiatrists (Retired)

HPA 15-2: Covered and Non-Covered Inpatient Hospital Days (Retired. Refer to MCO Manual.) 

HPA 15-1: Medicaid Tuberculosis (TB) Program (Retired)

HPA 14-16: Member Admissions to Skilled Nursing Facilities (Retired)

HPA 14-15: Update to DME Enteral Nutrition Fee Schedule (Retired)

HPA 14-14: Correction of Assistant Surgeon Fee for CPT Code 59514 (Retired)

HPA 14-13: Radiation Treatment Management: Billing Clarification (Retired)

HPA 14-12: Administrative Corrections for Retro Enrolled Newborns and Excluded Populations (Retired. Refer to MCO Manual.)

HPA 14-11: Coverage of Compression Garments and Related Items (Retired)

HPA 14-10: Coverage of Oncotype DX, Breast Cancer Assay for the Determination of Breast Cancer Prognosis (Retired)

HPA 14-9: Long Acting Reversible Contraceptives in Hospital Settings (Retired. Refer to MCO Manual.)

HPA 14-8: Provisional Medicaid Program Approved (Retired)

HPA 14-7: Inclusion of Hospice Care into Bayou Health Core Benefits and Services (Retired. Refer to Medicaid Services Manual, Hospice.)

HPA 14-6: Makena Coverage Effective May 1, 2014 (Retired)

HPA 14-5: DME: Standing Frame Criteria and Form (Retired. Refer to Medicaid Services Manual, Durable Medical Equipment.)

HPA 14-4: Billing TPL Claims for Shared Plans (Retired)

HPA 14-3: Rehabilitation Therapy-Reimbursement Methodology Change

HPA 14-2: 2014 Healthcare Common Procedure Coding System (HCPCS) Update (Retired)

HPA 14-1: National Correct Coding Initiative Update (Retired)

HPA 13-19: LTSS Provider Recruitment (Retired. Refer to MCO Manual.)

HPA 13-18: Allergy Testing Update (Retired)

HPA 13-17: Rate Changes (Retired)

HPA 13-16: FQHC and RHC Crossover and Third Party Billing (Retired)

HPA 13-15: Medicaid Eligibility Based on SSI (Retired. Refer to MCO Manual.)

HPA 13-14: Crossover Code Indicator (Retired)

HPA 13-13: Certificate of Creditable Coverage (Retired. Refer to MCO Manual.)

HPA 13-12: Wearable Cardioverter Defibrillator (WCD) as a Covered Service (Retired)

HPA 13-11: Individual Physical Therapists (Retired)

HPA 13-10: Hospital DSMT Policy Update (Retired. Refer to MCO Manual.)

HPA 13-9: Continuation of Benefits (Retired. Refer to MCO Manual.)

HPA 13-8: Speech Therapy Services Update (Retired)

HPA 13-7: Prior Authorization of HIV-AIDS Drugs (Retired)

HPA 13-6: Skilled Nursing Facility Encounter Claims (Retired. Refer to MCO Manual.)

HPA 13-5: Update Regarding Fees Related to New 2013 HCPCS Codes (Retired)

HPA 13-4: Clarification of Authorization Representative (Retired. Refer to MCO Manual.)

HPA 13-3: Marketing Guidance Under ACA Exchanges (Revised June 28, 2017)

HPA 13-2: Invalid Codes (Retired)

HPA 13-1: Radiology Utilization Management Program (Retired)

HPA 12-9: Provider Disputes (Retired. Refer to MCO Manual and IB 19-3.) 

HPA 12-8: Sterilization Consent Form (Retired. Refer to MCO Manual.)

HPA 12-7: Pediatric Day Health Care (Retired. Refer to Medicaid Services Manual, Pediatric Day Health Care.)

HPA 12-6: Breast Reconstructive Surgery (Retired. Refer to MCO Manual.)

HPA 12-5: Fee Schedule Advisory (Retired)

HPA 12-4: DCFS Staff Contacts (Retired)

HPA 12-3: Abortion Policy (Retired)

HPA 12-2: Check Hold Date (Retired)

HPA 12-1: Oral Surgery (Retired)

 

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