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-HBL-258	Health Care Management Denial	7/7/2026	8/21/2026	Pending	Health Care Management Denial
2026-LHCC-499	Retrospective Review For Services Requiring Authorizations	7/7/2026	8/21/2026	Pending	Retrospective Review For Services Requiring Authorizations
2026-HBL-779	Concurrent Review Policy	7/7/2026	8/21/2026	Pending	Concurrent Review Policy
2026-LHCC-1449	Practitioner Credentialing and Recredentialing	7/7/2026	8/21/2026	Pending	Practitioner Credentialing and Recredentialing
2026-LHCC-1504	Reporting the Global Maternity Package	7/7/2026	8/21/2026	Pending	Reporting the Global Maternity Package
2026-HUM-1541	Crisis Stabilization for Children and Adolescents	7/7/2026	8/21/2026	Pending	Crisis Stabilization for Children and Adolescents
2026-LHCC-1822	Opioid Use Disorder (OUD) treatment in Opioid Treatment Programs	7/7/2026	8/21/2026	Pending	Opioid Use Disorder (OUD) treatment in Opioid Treatment Programs
2026-HBL-2461	Cardiac Resynchronization Therapy	7/7/2026	8/21/2026	Pending	Cardiac Resynchronization Therapy
2026-HBL-2897	EDI Edit Billed Chrgs and Units NL	7/7/2026	8/21/2026	Pending	EDI Edit Billed Chrgs and Units NL
2026-HBL-951	Durable Medical Equipment	6/26/2026	8/10/2026	Pending	Durable Medical Equipment
2026-LHCC-1513	Continuity and Coordination of Services	6/26/2026	8/10/2026	Pending	Continuity and Coordination of Services
2026-ACLA-2898	Pediatric Bed Enclosure	6/26/2026	8/10/2026	Pending	Pediatric Bed Enclosure
2026-HUM-1537	Mental Health Rehabilitation Services – Community Psychiatric Support and Treatment and Psychosocial Rehabilitation	6/22/2026	8/6/2026	Pending	Mental Health Rehabilitation Services – Community Psychiatric Support and Treatment and Psychosocial Rehabilitation
2026-LHCC-1947	ADHD	6/22/2026	8/6/2026	Pending	ADHD
2026-HBL-2899	ILOS Policy and Procedure Visions of Hope Community Services	6/22/2026	8/6/2026	Pending	ILOS Policy and Procedure Visions of Hope Community Services
2026-ACLA-2910	Autologous Fat Grafting Injectable Soft Tissue Fillers	6/22/2026	8/6/2026	Pending	Autologous Fat Grafting Injectable Soft Tissue Fillers
2026-ACLA-2911	Balloon Spacer Devices Massive Rotator Cuff Tears	6/22/2026	8/6/2026	Pending	Balloon Spacer Devices Massive Rotator Cuff Tears
2026-ACLA-2912	Transcatheter Therapy Severe Tricuspid Regurgitation	6/22/2026	8/6/2026	Pending	Transcatheter Therapy Severe Tricuspid Regurgitation
2026-ACLA-2913	ZOLL Heart Failure Management System	6/22/2026	8/6/2026	Pending	ZOLL Heart Failure Management System
2026-ACLA-2915	Transperineal Laser Ablation Benign Prostatic Hyperplasia	6/22/2026	8/6/2026	Pending	Transperineal Laser Ablation Benign Prostatic Hyperplasia
2026-ACLA-1183	Personal Care Services	6/22/2026	8/6/2026	Pending	Personal Care Services
2026-ACLA-2914	Skin Substitutes for Chronic Wounds	6/22/2026	8/6/2026	Pending	Skin Substitutes for Chronic Wounds
2026-LHCC-687	Measurable Progressive Improvement	6/12/2026	7/27/2026	Pending	Measurable Progressive Improvement
2026-ACLA-1185	Individual Placement and Support	6/12/2026	7/27/2026	Pending	Individual Placement and Support
2026-LHCC-1213	Sacroiliac Joint Fusion	6/12/2026	7/27/2026	Pending	Sacroiliac Joint Fusion
2026-LHCC-1430	Record Keeping and Documentation Standards: Physical Medicine	6/12/2026	7/27/2026	Pending	Record Keeping and Documentation Standards: Physical Medicine
2026-LHCC-1588	Member Advisory of Provider Contract Termination or Limitation Policy	6/12/2026	7/27/2026	Pending	Member Advisory of Provider Contract Termination or Limitation Policy
2026-LHCC-1711	Sympathetic Nerve Block	6/12/2026	7/27/2026	Pending	Sympathetic Nerve Block
2026-LHCC-1750	Sacroiliac Joint Injections – NIA	6/12/2026	7/27/2026	Pending	Sacroiliac Joint Injections – NIA
2026-LHCC-1751	Spinal Cord Stimulation – NIA	6/12/2026	7/27/2026	Pending	Spinal Cord Stimulation – NIA
2026-LHCC-1752	Epidural Spine Injections	6/12/2026	7/27/2026	Pending	Epidural Spine Injections
2026-LHCC-1754	Epidural Spine Injection Trial Intrathecal Hybrid	6/12/2026	7/27/2026	Pending	Epidural Spine Injection Trial Intrathecal Hybrid
2026-LHCC-1755	Paravertebral Facet Joint injections or blocks	6/12/2026	7/27/2026	Pending	Paravertebral Facet Joint injections or blocks
2026-LHCC-1756	Facet Joint Denervation	6/12/2026	7/27/2026	Pending	Facet Joint Denervation
2026-LHCC-1878	Cervical Spine Surgery	6/12/2026	7/27/2026	Pending	Cervical Spine Surgery
2026-LHCC-1880	Hip Arthroplasty	6/12/2026	7/27/2026	Pending	Hip Arthroplasty
2026-LHCC-1881	Hip Arthroscopy	6/12/2026	7/27/2026	Pending	Hip Arthroscopy
2026-LHCC-1882	Knee Arthroplasty	6/12/2026	7/27/2026	Pending	Knee Arthroplasty
2026-LHCC-1883	Lumbar Artificial Disc Replacement	6/12/2026	7/27/2026	Pending	Lumbar Artificial Disc Replacement
2026-LHCC-1884	Lumbar Spine Surgery	6/12/2026	7/27/2026	Pending	Lumbar Spine Surgery
2026-LHCC-1885	Knee Arthroscopy	6/12/2026	7/27/2026	Pending	Knee Arthroscopy
2026-LHCC-1887	Shoulder Arthroplasty	6/12/2026	7/27/2026	Pending	Shoulder Arthroplasty
2026-LHCC-1889	Shoulder Arthroscopy	6/12/2026	7/27/2026	Pending	Shoulder Arthroscopy
2026-HBL-2894	Critical Care to Home	6/12/2026	7/27/2026	Pending	Critical Care to Home
2026-HBL-2906	UM AROW CMBM A2025M5320	6/12/2026	7/27/2026	Pending	UM AROW CMBM A2025M5320
2026-LHCC-2908	Active Procedures, Passive Treatment, & Experimental, Unproven, or Investigational Services	6/12/2026	7/27/2026	Pending	Active Procedures, Passive Treatment, & Experimental, Unproven, or Investigational Services
2026-LHCC-2909	Outpatient Habilitative Physical, Occupational, Speech, and Rehabilitative Speech Therapy	6/12/2026	7/27/2026	Pending	Outpatient Habilitative Physical, Occupational, Speech, and Rehabilitative Speech Therapy
2026-LHCC-110	Continued Stay and Discharge Planning	6/4/2026	7/19/2026	Pending	Continued Stay and Discharge Planning
2026-HBL-2892	UM AROW A2026M5644	6/4/2026	7/19/2026	Pending	UM AROW A2026M5644
2026-ABH-2358	AMA 7100.72 CPT Vest High Frequency	5/29/2026	7/13/2026	Pending	AMA XXXX CPT Vest-High Frequency Chest Wall Oscillation Device
2026-ACLA-1223	Hospice Prior Authorization	5/29/2026	7/13/2026	Pending	Hospice Prior Authorization
2026-ACLA-1442	Prior Authorization Service List	5/29/2026	7/13/2026	Pending	ACLA Prior Authorization Service List
2026-ACLA-1859	Nonpharmacologic Treatments for Chronic Vertigo	5/29/2026	7/13/2026	Pending	Nonpharmacologic Treatments for Chronic Vertigo
2026-ACLA-1871	Three Dimensional Imaging Interpretation	5/29/2026	7/13/2026	Pending	Three Dimensional Imaging Interpretation
2026-ACLA-2313	Microwave Thermotherapy Lung Kidney Tumors	5/29/2026	7/13/2026	Pending	Microwave Thermotherapy Lung Kidney Tumors
2026-ACLA-2432	Air Ambulance Transport	5/29/2026	7/13/2026	Pending	Air Ambulance Transport
2026-ACLA-2902	Continuous Positive Airway Pressure	5/29/2026	7/13/2026	Pending	Continuous Positive Airway Pressure
2026-ACLA-2903	Hospital Services Prior Authorization	5/29/2026	7/13/2026	Pending	Hospital Services Prior Authorization
2026-ACLA-2904	Outpatient Therapy Licensed Practitioners	5/29/2026	7/13/2026	Pending	Outpatient Therapy Licensed Practitioners
2026-ACLA-2905	Hysterectomy	5/29/2026	7/13/2026	Pending	Hysterectomy
2026-HBL-2878	Infusion Administration Facility	5/29/2026	7/13/2026	Pending	Infusion Administration Facility
2026-HBL-2879	UM AROW M5341 M5503 CMBM CD	5/29/2026	7/13/2026	Pending	UM AROW M5341 M5503 CMBM CD
2026-HUM-2316	Hospital-Based Care Coordination of Pregnant Members with Substance Use Disorder - In Lieu of Service	5/22/26	7/5/26	Approved	Hospital-Based Care Coordination of Pregnant Members with Substance Use Disorder - In Lieu of Service
2026-ACLA-2221	Provider Quality Monitoring Strategy	5/22/26	7/6/26	Approved	Provider Quality Monitoring Strategy
2026-HUM-1556	Care Management Program Description	5/22/26	7/6/26	Approved	Care Management Production Description
2026-LHCC-1385	Implantable Wireless PAP Monitoring	5/22/26	7/6/26	Approved	Implantable Wireless PAP Monitoring
2026-HBL-1036	Home Health Utilization Management	5/22/26	7/6/26	Approved	Home Health Utilization Management
2026-LHCC-991	Concurrent Review	5/22/26	7/6/26	Approved	Concurrent Review
2026-HBL-330	Case Management	5/22/26	7/6/26	Approved	Case Management
2026-HBL-946	Member Appeals Core Policy	5/14/26	6/28/26	Approved	Member Appeals Core Process Physical Health
2026-LHCC-1111	Thyroid Insulin Test in Ped	5/14/26	6/28/26	Approved	Thyroid Hormones and Insulin Testing in Pediatrics
2026-LHCC-1113	Cardiac Biomarker Testing	5/14/26	6/28/26	Approved	Cardiac Biomarker Testing
2026-LHCC-1115	Vitamin D Testing in Peds	5/14/26	6/28/26	Approved	Vitamin D Testing in Children and Adolescents
2026-LHCC-1168	Allergy Testing & Therapy	5/14/26	6/28/26	Approved	Allergy Testing and Therapy
2026-LHCC-1216	Bariatric Surgery	5/14/26	6/28/26	Approved	Bariatric Surgery
2026-LHCC-1227	Skin and Soft Tissue Substitutes for Chronic Wounds	5/14/26	6/28/26	Approved	Skin and Soft Tissue Substitutes
2026-LHCC-1279	Measure Serum 1.25 Vit D	5/14/26	6/28/26	Approved	Measurement of Serum 1,25 Vitamin D
2026-LHCC-1280	EEG Headache	5/14/26	6/28/26	Approved	EEG in the Evaluation of Headache
2026-LHCC-1356	Lung Transplantation	5/14/26	6/28/26	Pending	Lung Transplantation
2026-LHCC-1386	Sclerotherapy and Chemical Endovenous Ablation for Varicose Veins	5/14/26	6/28/26	Approved	Sclerotherapy and Chemical Endovenous Ablation for Varicose Veins and Other
2026-LHCC-1387	Percutaneous LAAD Stroke Prevention	5/14/26	6/28/26	Approved	Percutaneous Left Atrial Appendage Closure Device for Stroke Prevention
2026-LHCC-1527	Nerve Blocks and Neurolysis for Pain Management	5/14/26	6/28/26	Approved	Nerve Blocks and Neurolysis for Pain Management
2026-LHCC-1701	Outpatient Testing for DOA (Drugs of Use)	5/14/26	6/28/26	Approved	Drugs of Use Presumptive and Definitive Testing
2026-LHCC-1703	Pediatric Kidney Transplant	5/14/26	6/28/26	Approved	Pediatric Kidney Transplant
2026-LHCC-1705	Invasive and Non-Invasive Home Ventilator	5/14/26	6/28/26	Approved	Home Ventilators
2026-LHCC-1706	Wireless Motility Capsule	5/14/26	6/28/26	Approved	Wireless Motility Capsule
2026-LHCC-1747	PCS-EPSDT Policy	5/14/26	6/28/26	Approved	PCS EPSDT Policy
2026-ABH-2351	AMA XXXX Continuous Positive Airway Pressure	5/14/26	6/28/26	Approved	AMA 7100.70 Continuous Positive Airway Pressure
2026-HUM-2608	Outpatient Lactation Support ILOS	5/14/26	6/28/26	Approved	Outpatient Lactation Support Provider
2026-HBL-2886	Maternity Services Comms RP	5/14/26	6/28/26	Approved	Maternity Services Comms
2026-LHCC-2895	Immobilized Lipase Cartridges (RELiZORB)	5/14/26	6/28/26	Approved	Immobilized Lipase Cartridges
2026-HBL-2896	UM AROW M5513 CMBM CD	5/14/26	6/28/26	Approved	UM AROW M5513 CMBM CD