Managed Care Policies & Procedures

COVID-19 Update: Changes to Medicaid policy and procedure deemed of an imminent peril to the public health, safety, or welfare and requiring immediate approval, such as those related to COVID-19, are exempt from the legislative requirement to publish the proposed policy or procedure for public comment prior to implementation. To keep abreast of these exempted changes to policy and procedure related to COVID-19, refer to the Coronavirus (COVID-19) Medicaid Information website, which provides guidance to Medicaid providers and managed care organizations, emergency rules, and requests LDH has submitted to the Centers for Medicare & Medicaid Services (CMS). Broader information related to COVID-19 can be found at http://ldh.la.gov/Coronavirus/.

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. To provide feedback, please complete this form. Refer to the links below the table for archived postings and public comments.

To see the LDH and managed care organization Pharmacy and Medical Drug Policies, click here.

To see Dental Benefit Plan Manager Policies, click here.

Item Number Policy/Procedure Date Posted Comment Period Closed Status Document Links
2022-HBL-1189 Lab Test Aid in the Diagnosis of Heart Transp Rej 1/20/22 3/6/22 Pending Lab Test Aid in the Diagnosis of Heart Transp Rej
2022-HBL-1188 Wirls Cap for Eval of Susp Gastric and Intest Mot Disorders 1/20/22 3/6/22 Pending Wirls Cap for Eval of Susp Gastric and Intest Mot Disorders
2022-HBL-1187 Transtympanic Micropressure 1/20/22 3/6/22 Pending Transtympanic Micropressure
2022-HBL-1186 Intrapulmonary Percussive Ventilation Devices 1/20/22 3/6/22 Pending Intrapulmonary Percussive Ventilation Devices
2022-ACLA-1185 Individual Placement and Support 1/20/22 3/6/22 Pending Individual Placement and Support
2022-HBL-1088 Vert Bdy Stap Tether for Trtmnt Scoliosis in Child and Adol 1/20/22 3/6/22 Pending Vert Bdy Stap Tether for Trtmnt Scoliosis in Child and Adol
2022-LHCC-914 Care Plan Development and Implementation 1/20/22 3/6/22 Pending Care Plan Development and Implementation
2022-LHCC-329 Adverse Determinations 1/20/22 3/6/22 Pending Adverse Determinations
2022-HBL-1182 Pneumatic Compression Devices for Prevention of Deep Vein Thrombosis of the Extremities in the Home Setting 1/14/22 2/28/22 Pending Pneumatic Compression Devices for Prevention of Deep Vein Thrombosis of the Extremities in the Home Setting
2022-HBL-1183 Personal Care Services 1/14/22 2/28/22 Pending Personal Care Services
2022-HBL-1184 Gene Expression Profiling for Idiopathic Pulmonary Fibrosis 1/14/22 2/28/22 Pending Gene Expression Profiling for Idiopathic Pulmonary Fibrosis
2022-LDH-3 MCO Manual > Part 4: Services > In Lieu of Services > Behavioral Health Services (Proposed effective date = 1/1/2022) 1/12/22 2/26/22 Pending MCO Manual - In Lieu of Services BH
2022-LDH-2 MCO Manual > Part 4: Services > In Lieu of Services (Proposed effective date = 1/1/2022) 1/7/22 2/21/22 Pending In Lieu of Services
2022-ACLA-1181 Brain (head) MRA 1/7/22 2/21/22 Pending Brain (head) MRA
2022-ACLA-1148 Unlisted Studies 1/7/22 2/21/22 Pending Unlisted Studies
2022-ACLA-891 Abdomen MRI, MRCP 1/7/22 2/21/22 Pending Abdomen MRI, MRCP
2022-ACLA-882 Brain (Head) MRI, Brain (Head) MRI with IAC (Internal Auditory Canal) 1/7/22 2/21/22 Pending Brain (Head) MRI, Brain (Head) MRI with IAC (Internal Auditory Canal)
2022-ACLA-880 Cervical Spine MRI 1/7/22 2/21/22 Pending Cervical Spine MRI
2022-ACLA-878 Chest (Thorax) MRI 1/7/22 2/21/22 Pending Chest (Thorax) MRI
2022-ACLA-871 Sinus Face Orbit MRI 1/7/22 2/21/22 Pending Sinus Face Orbit MRI
2022-ACLA-863 Thoracic Spine MRI 1/7/22 2/21/22 Pending Thoracic Spine MRI
2022-ACLA-861 Breast MRI 1/7/22 2/21/22 Pending Breast MRI
2022-ACLA-859 Upper Extremity MRI 1/7/22 2/21/22 Pending Upper Extremity MRI
2022-ACLA-853 Heart MRI 1/7/22 2/21/22 Pending Heart MRI
2022-ACLA-848 Lower Extremity MRI (foot, ankle, knee, leg, or hip MRI 1/7/22 2/21/22 Pending Lower Extremity MRI (foot, ankle, knee, leg, or hip MRI
2022-ACLA-847 Lumber Spine MRI  1/7/22  2/21/22  Pending  Lumber Spine MRI 
2022-ACLA-836 Pelvic MRI 1/7/22 2/21/22 Pending Pelvic MRI
2022-HBL-986 Diagnostic Coronary Angiography (AIM) 1/7/22 2/21/22 Pending Diagnostic Coronary Angiography (AIM)
2021-ABH-1180 Process for Approving and Applying Medical Necessity Criteria 1/7/22 2/21/22 Pending Process for Approving and Applying Medical Necessity Criteria
2021-UHC-1178 Liposuction for Lipodema 1/7/22 2/21/22 Pending Liposuction for Lipodema
2021-HBL-1175 Drug Screen Policy 1/7/22 2/21/22 Pending Drug Screen Policy
2022-LDH-1 MCO Manual > Part 4: Services > Personal Care Services (Proposed effective date = 2/21/2022) 1/6/2022 2/20/2022 Pending Personal Care Services (Proposed effective date = 2/21/2022)
2021-ABH-1169 Provider Appeals Policy 12/23/21 2/6/22 Pending Provider Appeals Policy
2021-ABH-1176 Act 421 Policy 12/22/21 2/5/22 Pending Act 421 Policy
2021-LDH-17

MCO Manual > Part 4: Services > Pharmacy > Brand Name and Generic Drugs (Proposed effective date = 3/13/2022)

12/22/21 2/5/22 Pending MCO Manual > Pharmacy Brand Name & Generic Drugs
2021-LDH-16

MCO Manual > Part 4: Services > Ambulatory Surgical Services > Outpatient Hospital Ambulatory Surgery (Proposed effective date = 3/13/2022)

12/22/21 2/5/22 Pending

MCO Manual > Outpatient Hospital Ambulatory Surgery

2021-LDH-15

MCO Manual > Part 4: Services > Professional Services > Sinus Procedures

(Proposed effective date = 3/6/2022)

12/14/21 1/28/22 Pending

MCO Manual > Part 4: Services > Professional Services > Sinus Procedures

(Proposed effective date = 3/6/2022)

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