Medicaid Managed Care Policies & Procedures

In accordance with La. R.S. 46:460.51, et seq., prior to adopting, approving, amending, or implementing certain policies or procedures, LDH will publish the proposed policy or procedure for the purpose of soliciting public comments. For this purpose, a policy or procedure, as defined by the statute, shall mean a requirement governing the administration of managed care organizations specific to billing guidelines, medical management and utilization review guidelines, case management guidelines, claims processing guidelines and edits, grievance and appeals procedures and process, other guidelines or manuals containing pertinent information related to operations and pre-processing claims, and core benefits and services.

The following table contains the LDH and managed care organization policies and procedures that are open for public comment.

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Item Number	Policy/Procedure	Date Posted	Comment Period Closed	Status	Document Links
2026-LHCC-1213	Sacroiliac Joint Fusion Evolent	3/20/26	5/4/26	Pending	Sacroiliac Joint Fusion Evolent
2026-HUM-1584	Therapeutic Group Home	3/20/26	5/4/26	Pending	Therapeutic Group Home
2026-LHCC-423	EPSDT	3/20/26	5/4/26	Pending	EPSDT
2026-ABH-1331	Supporting Members in Crisis	3/20/26	5/4/26	Pending	Supporting Members in Crisis
2026-HUM-1540	Crisis Stabilization for Adults	3/20/26	5/4/26	Pending	Crisis Stabilization for Adults
2026-ACLA-2769	Call Center Manual	3/20/26	5/4/26	Pending	Call Center Manual
2026-HBL-2799	LA Provider Training	3/20/26	5/4/26	Pending	LA Provider Training
2026-ACLA-844	Low Field MRI	3/13/26	4/27/26	Pending	Low Field MRI
2026-ACLA-850	Lower Extremity CT	3/13/26	4/27/26	Pending	Lower Extremity CT
2026-ACLA-851	Low Dose CT for Lung Cancer Screening	3/13/26	4/27/26	Pending	Low Dose CT for Lung Cancer Screening
2026-ACLA-856	Functional Brain MRI	3/13/26	4/27/26	Pending	Functional Brain MRI
2026-ACLA-861	Breast MRI	3/13/26	4/27/26	Pending	Breast MRI
2026-ACLA-874	CT (Virtual) Colonoscopy	3/13/26	4/27/26	Pending	CT (Virtual) Colonoscopy
2026-ACLA-875	Chest (Thorax) CT	3/13/26	4/27/26	Pending	Chest (Thorax) CT
2026-ACLA-876	Chest CTA	3/13/26	4/27/26	Pending	Chest CTA
2026-ACLA-877	Chest MRA	3/13/26	4/27/26	Pending	Chest MRA
2026-ACLA-878	Chest (Thorax) MRI	3/13/26	4/27/26	Pending	Chest (Thorax) MRI
2026-ACLA-879	Brain (Head) MRS	3/13/26	4/27/26	Pending	Brain (Head) MRS
2026-ACLA-880	Cervical Spine MRI	3/13/26	4/27/26	Pending	Cervical Spine MRI
2026-ACLA-881	Cervical Spine CT	3/13/26	4/27/26	Pending	Cervical Spine CT
2026-ACLA-882	Brain (Head) MRI, Brain (Head) MRI with IAC (Internal Auditory Canal)	3/13/26	4/27/26	Pending	Brain (Head) MRI, Brain (Head) MRI with IAC (Internal Auditory Canal)
2026-ACLA-883	Brain (Head) CT	3/13/26	4/27/26	Pending	Brain (Head) CT
2026-ACLA-884	Brain (Head) MRA/MRV	3/13/26	4/27/26	Pending	Brain (Head) MRA/MRV
2026-ACLA-885	Brain (Head) CTA	3/13/26	4/27/26	Pending	Brain (Head) CTA
2026-ACLA-886	Bone Marrow MRI	3/13/26	4/27/26	Pending	Bone Marrow MRI
2026-ACLA-887	Abdominal Arteries CTAngiography	3/13/26	4/27/26	Pending	Abdominal Arteries CTAngiography
2026-ACLA-888	Abdomen/Pelvis CTA Combo	3/13/26	4/27/26	Pending	Abdomen/Pelvis CTA Combo
2026-ACLA-889	Abdomen MRA (Angiography)	3/13/26	4/27/26	Pending	Abdomen MRA (Angiography)
2026-ACLA-890	Abdomen/Pelvis CT Combo	3/13/26	4/27/26	Pending	Abdomen/Pelvis CT Combo
2026-ACLA-891	Abdomen MRI, MRCP	3/13/26	4/27/26	Pending	Abdomen MRI, MRCP
2026-ACLA-892	Abdomen CT	3/13/26	4/27/26	Pending	Abdomen CT
2026-ACLA-893	Abdomen CTAngiography	3/13/26	4/27/26	Pending	Abdomen CTAngiography
2026-LHCC-934	Behavioral Health Provider Quality Program	3/13/26	4/27/26	Pending	Behavioral Health Provider Quality Program
2026-ACLA-1147	Brain PET Scan	3/13/26	4/27/26	Pending	Brain PET Scan
2026-LHCC-1833	Assertive Community Treatment (ACT)	3/13/26	4/27/26	Pending	Assertive Community Treatment (ACT)
2026-LDH-1	MCO Manual > Part 4: Services > Professional Services > Obstetrics; effective date: 5/30/2026	3/9/26	4/23/26	Pending	MCO Manual - Doula Services
2026-LDH-2	MCO Manual > Part 4: Services > Pharmacy > Medication Therapy Management; effective date: 5/30/2026	3/9/26	4/23/26	Pending	MCO Manual - Cell and Gene Therapy Model
2026-LDH-3	MCO Manual > Part 4: Services > Medical Transportation; effective date: 5/30/2026	3/9/26	4/23/26	Pending	MCO Manual - Medical Transportation
2026-LDH-4	MCO Manual > Part 11: Enrollee Services > Grievances, Appeal and State Fair Hearing; effective date: 5/30/2026	3/9/26	4/23/26	Pending	MCO Manual - Grievances, Appeal and State Fair Hearing
2026-LDH-5	MCO Manual > Part 15: Program Integrity; effective date: 5/30/2026	3/9/26	4/23/26	Pending	MCO Manual - Program Integrity
2026-LDH-6	MCO Manual > Part 9: Provider Network > Credentialing and Re-Credentialing of Providers and Clinical Staff > Specialized Behavioral Health Providers; effective date: 5/30/2026	3/9/26	4/23/26	Pending	MCO Manual - Specialized Behavioral Health Providers
2026-LDH-7	MCO Manual > Part 4: Services > Professional Services > In Lieu of Services; effective date: 5/30/2026	3/9/26	4/23/26	Pending	MCO Manual - ILOS
2026-LDH-8	MCO Manual > Part 4: Services > Professional Services > Physician Adminstered Drugs; effective date: 5/30/2026	3/9/26	4/23/26	Pending	MCO Manual - Physician Administered Drugs
2026-HBL-2756	Remote Patient Monitoring In Lieu of Service (ILOS)	3/9/26	4/23/26	Pending	Remote Patient Monitoring In Lieu of Service (ILOS)
2026-ABH-1179	Prior Authorizations	3/9/26	4/23/26	Pending	Prior Authorizations
2026-LHCC-2184	Organizational Assessment and Reassessment	3/9/26	4/23/26	Pending	Organizational Assessment and Reassessment
2026-ABH-2254	Benefit Exception Amendment	3/9/26	4/23/26	Pending	Benefit Exception Amendment
2026-HBL-2790	PA Req Chngs-UM AROW CAID	3/9/26	4/23/26	Pending	PA Req Chngs-UM AROW CAID
2026-ACLA-2795	Pre-Adjudication of Provider Claims for Diagnosis Accuracy	3/9/26	4/23/26	Pending	Pre-Adjudication of Provider Claims for Diagnosis Accuracy
2026-LHCC-2450	Pharmacy Prior Authorization and Medical Necessity	2/27/26	4/13/26	Pending	Pharmacy Prior Authorization and Medical Necessity
2026-LHCC-140	Timeliness of UM Decisions	2/27/26	4/13/26	Pending	Timeliness of UM Decisions
2026-LHCC-429	UM Program Description	2/27/26	4/13/26	Pending	UM Program Description
2026-LHCC-1909	Peer Support Services	2/27/26	4/13/26	Pending	Peer Support Services
2026-LHCC-1916	Individual Placement and Support	2/27/26	4/13/26	Pending	Individual Placement and Support
2026-ABH-2253	Utilization Management Timeliness Standards and Decision Notification Amendment	2/27/26	4/13/26	Pending	Utilization Management Timeliness Standards and Decision Notification Amendment
2026-ABH-2256	Assertive Community Treatment (ACT)	2/27/26	4/13/26	Pending	Assertive Community Treatment (ACT)
2026-HBL-2496	Genetic Tests One Per Life Comms	2/27/26	4/13/26	Pending	Genetic Tests One Per Life Comms
2026-HBL-2781	EXPRESS ABA Claim Processing	2/20/26	4/6/26	Pending	EXPRESS ABA Claim Processing
2026-ACLA-1442	ACLA Prior Authorization Service List	2/20/26	4/6/26	Pending	ACLA Prior Authorization Service List
2026-LHCC-1872	Retroactive Reimbursement	2/20/26	4/6/26	Pending	Retroactive Reimbursement
2026-ABH-2362	AMA XXXX Home Health and Extended Home Health	2/20/26	4/6/26	Pending	AMA XXXX Home Health and Extended Home Health
2026-HBL-2791	Quality of Care	2/20/26	4/6/26	Pending	Quality of Care
2026-ABH-1433	Member transition	2/13/26	3/30/26	Pending	Member transition
2026-ABH-2349	Bariatric Surgery	2/13/26	3/30/26	Pending	Bariatric Surgery
2026-ABH-2350	BRCA Genetic Testing and Counseling	2/13/26	3/30/26	Pending	BRCA Genetic Testing and Counseling
2026-HUM-2767	CPT-9328	2/13/26	3/30/26	Pending	CPT-9328
2026-HUM-2768	CPT-9327	2/13/26	3/30/26	Pending	CPT-9327
2026-HUM-2778	Documentation Requirements for Hysterectomy and Sterilization	2/13/26	3/30/26	Pending	Documentation Requirements for Hysterectomy and Sterilization
2026-HUM-2788	Correct Coding	2/13/26	3/30/26	Pending	Correct Coding
2026-HBL-2794	Infusion Administration Facility Editing Update	2/13/26	3/30/26	Pending	Infusion Administration Facility Editing Update
2026-LHCC-329	Adverse Determinations	2/13/26	3/30/26	Pending	Adverse Determinations
2026-LHCC-497	Emergency Services Policy	2/13/26	3/30/26	Pending	Emergency Services Policy
2026-ABH-1173	Peer Support Services	2/13/26	3/30/26	Pending	Peer Support Services
2026-HBL-1286	Unlisted or Miscellaneous Codes	2/13/26	3/30/26	Pending	Unlisted or Miscellaneous Codes
2026-HUM-2792	Genetics	2/13/26	3/30/26	Pending	Genetics
2026-HUM-2793	CPT	2/13/26	3/30/26	Pending	CPT
2026-LHCC-1416	Transportation Policy	2/13/26	3/30/26	Pending	Transportation Policy
2026-HUM-2649	LA MCD PAL A	2/13/26	3/30/26	Pending	LA MCD PAL A
2026-HUM-2796	Durable Medical Equipment, Maintenance and Repair	2/13/26	3/30/26	Pending	Durable Medical Equipment, Maintenance and Repair
2026-LHCC-54	Primary Care Provider (PCP) Selection and Change	2/12/26	3/29/26	Pending	Primary Care Provider (PCP) Selection and Change
2026-HBL-819	HBL Provider Manual	2/12/26	3/29/26	Pending	HBL Provider Manual
2026-LHCC-922	Fraud, Waste, and Abuse Plan	2/12/26	3/29/26	Pending	Fraud, Waste, and Abuse Plan
2026-ABH-955	Crisis Intervention (CI) Services	2/12/26	3/29/26	Pending	Crisis Intervention (CI) Services
2026-HUM-1561	Multi-Systemic Therapy (MST)	2/12/26	3/29/26	Pending	Multi-Systemic Therapy (MST)
2026-HUM-1818	Functional Family Therapy (FFT)	2/12/26	3/29/26	Pending	Functional Family Therapy (FFT)
2026-HUM-2782	Genetics	2/12/26	3/29/26	Pending	Genetics
2026-HUM-2783	Correct Coding	2/12/26	3/29/26	Pending	Correct Coding
2026-HUM-2784	Correct Coding	2/12/26	3/29/26	Pending	Correct Coding
2026-HUM-2785	CPT - Lab/Pathology	2/12/26	3/29/26	Pending	CPT - Lab/Pathology
2026-HUM-2786	Correct Coding	2/12/26	3/29/26	Pending	Correct Coding
2026-HUM-2787	CPT-Medicine	2/12/26	3/29/26	Pending	CPT-Medicine
2026-ACLA-2789	Oxygen Concentrators	2/12/26	3/29/26	Pending	Oxygen Concentrators
2026-LHCC-899	Provider Manual PP	2/12/26	3/29/26	Pending	Provider Manual PP
2026-HUM-1535	Community Brief Crisis Support (CBCS)	2/12/26	3/29/26	Pending	Community Brief Crisis Support (CBCS)
2026-HUM-1580	Personal Care Services (PCS) for Adults with Serious Mental Illness (SMI)	2/12/26	3/29/26	Pending	Personal Care Services (PCS) for Adults with Serious Mental Illness (SMI)
2026-ACLA-1870	Behavioral Health Crisis Care	2/12/26	3/29/26	Pending	Behavioral Health Crisis Care
2026-LHCC-1912	Multi-Systemic Therapy	2/12/26	3/29/26	Pending	Multi-Systemic Therapy
2026-HUM-2180	Homebuilders	2/12/26	3/29/26	Pending	Homebuilders
2026-ACLA-2201	Therapeutic Group Homes	2/12/26	3/29/26	Pending	Therapeutic Group Homes
2026-HUM-2724	Freestanding Psychiatric Hospital for Adults ILOS	2/12/26	3/29/26	Pending	Freestanding Psychiatric Hospital for Adults ILOS
2026-ACLA-2753	Policy Emergency Department Evaluation and Management, Facility	2/12/26	3/29/26	Pending	Policy Emergency Department Evaluation and Management, Facility
2026-ABH-2761	Louisiana Visions of Hope Community Services Program	2/12/26	3/29/26	Pending	Louisiana Visions of Hope Community Services Program
2026-LHCC-725	CT/MRI Guidance for Needle Placement-CT Guidance for Radiation Fields	2/10/26	3/27/26	Pending	CT/MRI Guidance for Needle Placement-CT Guidance for Radiation Fields
2026-LHCC-768	Urgent/Emergent Criteria	2/10/26	3/27/26	Pending	Urgent/Emergent Criteria
2026-LHCC-770	Fractional Flow Reserve CT	2/10/26	3/27/26	Pending	Fractional Flow Reserve CT
2026-LHCC-1212	Spinal Cord Stimulation	2/10/26	3/27/26	Pending	Spinal Cord Stimulation
2026-LHCC-1218	Ventricular Assist Devices	2/10/26	3/27/26	Pending	Ventricular Assist Devices
2026-LHCC-1270	Urinary Incontinence Devices and Treatments	2/10/26	3/27/26	Pending	Urinary Incontinence Devices and Treatments
2026-LHCC-1271	Implantable Hypoglossal Nerve Stimulation for OSA	2/10/26	3/27/26	Pending	Implantable Hypoglossal Nerve Stimulation for OSA
2026-LHCC-1275	Oxygen Use and Concentrators	2/10/26	3/27/26	Pending	Oxygen Use and Concentrators
2026-HUM-1606	Louisiana UM Program Description	2/10/26	3/27/26	Pending	Louisiana UM Program Description
2026-LHCC-1764	Single Photon Emission Computed Tomography SPECT	2/10/26	3/27/26	Pending	Single Photon Emission Computed Tomography SPECT
2026-LHCC-1819	Burn Surgery	2/10/26	3/27/26	Pending	Burn Surgery
2026-LHCC-1821	Selective Dorsal Rhizotomy for Spasticity in CP	2/10/26	3/27/26	Pending	Selective Dorsal Rhizotomy for Spasticity in CP
2026-LHCC-1823	Mechanical Stretch devices	2/10/26	3/27/26	Pending	Mechanical Stretch devices
2026-LHCC-1824	Electric Tumor Treatment Fields	2/10/26	3/27/26	Pending	Electric Tumor Treatment Fields
2026-LHCC-1825	Proton and Neutron Beam Therapies	2/10/26	3/27/26	Pending	Proton and Neutron Beam Therapies
2026-LHCC-1837	Obstetrical Home Care Programs	2/10/26	3/27/26	Pending	Obstetrical Home Care Programs
2026-LHCC-1844	Transplant Service Documentation Requirements	2/10/26	3/27/26	Pending	Transplant Service Documentation Requirements
2026-LHCC-1905	Stereotactic Body Radiation Therapy	2/10/26	3/27/26	Pending	Stereotactic Body Radiation Therapy
2026-LHCC-1906	Facility-Based Sleep Studies for OSA	2/10/26	3/27/26	Pending	Facility-Based Sleep Studies for OSA
2026-LHCC-1907	Hyperhidrousis Treatments	2/10/26	3/27/26	Pending	Hyperhidrousis Treatments
2026-LHCC-1910	Implantable Intrathecal or Epidural Pain Pump	2/10/26	3/27/26	Pending	Implantable Intrathecal or Epidural Pain Pump
2026-LHCC-1948	Implantable Loop recorder	2/10/26	3/27/26	Pending	Implantable Loop recorder
2026-HUM-2797	Clinical Trials	2/10/26	3/27/26	Pending	Clinical Trials
2026-HUM-1543	EPSDT Personal Care Services (PCS)	2/10/26	3/27/26	Pending	EPSDT Personal Care Services (PCS)
2026-HUM-1590	Chiropractic ILOS	2/10/26	3/27/26	Pending	Chiropractic ILOS
2026-HUM-1664	Pediatric Day Health Care Clinical Coverage Policy	2/10/26	3/27/26	Pending	Pediatric Day Health Care Clinical Coverage Policy
2026-HUM-1669	Wound Care Clinical Coverage policy	2/10/26	3/27/26	Pending	Wound Care Clinical Coverage policy
2026-HUM-2686	Revenue Codes	2/10/26	3/27/26	Pending	Revenue Codes
2026-HUM-2754	CPT Evaluation and Management Service	2/10/26	3/27/26	Pending	CPT Evaluation and Management Service
2026-ABH-2762	Multiple Gestation	2/10/26	3/27/26	Pending	Multiple Gestation
2026-ABH-2763	Skyrizi	2/10/26	3/27/26	Pending	Skyrizi
2026-LHCC-608	Appeal of UM Decision	2/10/26	3/27/26	Pending	Appeal of UM Decision
2026-LHCC-1522	Notification of Pregnancy (NOP) Policy	2/10/26	3/27/26	Pending	Notification of Pregnancy (NOP) Policy
2026-LHCC-1841	MNC Policy for CPST and PSR	2/10/26	3/27/26	Pending	MNC Policy for CPST and PSR
2026-HUM-2608	Outpatient Lactation Support ILOS	2/10/26	3/27/26	Pending	Outpatient Lactation Support ILOS
2026-HUM-2718	Chiropractic Billing Guide	2/10/26	3/27/26	Pending	Chiropractic Billing Guide
2026-ACLA-2720	Home Delivered Meals	2/10/26	3/27/26	Pending	Home Delivered Meals
2026-HBL-2752	EXPRESS CDE Chisholm ABA	2/10/26	3/27/26	Pending	EXPRESS CDE Chisholm ABA
2026-LHCC-129	Provider Directory and Electronic Files from Portico	2/10/26	3/27/26	Pending	Provider Directory and Electronic Files from Portico
2026-LHCC-131	Vendor Management, JOC Attendees	2/10/26	3/27/26	Pending	Vendor Management, JOC Attendees
2026-LHCC-606	Grievance Process	2/10/26	3/27/26	Pending	Grievance Process
2026-LHCC-634	Encounter Data	2/10/26	3/27/26	Pending	Encounter Data
2026-LHCC-926	Provider Appointment Accessibility Standards	2/10/26	3/27/26	Pending	Provider Appointment Accessibility Standards
2026-LHCC-1877	Provider Directory for Members	2/10/26	3/27/26	Pending	Provider Directory for Members
2026-LHCC-1925	Specialty Pharmacy Program	2/10/26	3/27/26	Pending	Specialty Pharmacy Program
2026-UHC-2251	Private Duty Nursing (PDN) and Extended Home Health (EhH)	2/10/26	3/27/26	Pending	Private Duty Nursing (PDN) and Extended Home Health (EhH)
2026-LHCC-829	Interrater Reliability - Act 421	2/9/26	3/26/26	Pending	Interrater Reliability - Act 421
2026-HUM-2730	CPT	2/9/26	3/26/26	Pending	CPT
2026-HUM-2731	Correct Coding	2/9/26	3/26/26	Pending	Correct Coding
2026-HUM-2732	CPT Evaluation and Management Services	2/9/26	3/26/26	Pending	CPT Evaluation and Management Services
2026-HUM-2733	CPT Evaluation and Management Services	2/9/26	3/26/26	Pending	CPT Evaluation and Management Services
2026-HUM-2734	CPT Evaluation and Management Services	2/9/26	3/26/26	Pending	CPT Evaluation and Management Services
2026-HUM-2735	CPT Evaluation and Management Services	2/9/26	3/26/26	Pending	CPT Evaluation and Management Services
2026-HUM-2736	Units	2/9/26	3/26/26	Pending	Units
2026-HUM-2741	Drugs & Biologicals  HCPCS	2/9/26	3/26/26	Pending	Drugs & Biologicals  HCPCS