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.




Item Number  Policy/Procedure   Date Posted  Comment Period Closed   Status Document Links
2025-UHC-377 Implanted Electrical Stimulator for Spinal Cord 10/31/25 12/15/25 Pending Implanted Electrical Stimulator for Spinal Cord
2025-UHC-788 Mechanical Stretching Devices 10/31/25 12/15/25 Pending Mechanical Stretching Devices
2025-UHC-790 Nerve Graft to restore Erectile Function during Radical Prostatectomy 10/31/25 12/15/25 Pending Nerve Graft to restore Erectile Function during Radical Prostatectomy
2025-UHC-1815 Sacral Nerve Stimulation for Urinary and Fecal Indications 10/31/25 12/15/25 Pending Sacral Nerve Stimulation for Urinary and Fecal Indications
2025-UHC-2294 Molecular Oncology Testing for Hematologic Cancer Diagnosis, Prognosis, and Treatment Decisions 10/31/25 12/15/25 Pending Molecular Oncology Testing for Hematologic Cancer Diagnosis, Prognosis, and Treatment Decisions
2025-LHCC-430 Covered Benefits and Services 10/24/25 12/8/25 Pending Covered Benefits and Services
2025-HUM-1593 Provider Manual 10/24/25 12/8/25 Pending Provider Manual
2025-LHCC-1875 Ongoing Monitoring of Sanctions & Complaints 10/24/25 12/8/25 Pending Ongoing Monitoring of Sanctions & Complaints
2025-ABH-2253 Utilization Management Timeliness Standards and Decision Notification Amendment 10/24/25 12/8/25 Pending Utilization Management Timeliness Standards and Decision Notification Amendment
2025-UHC-215 Spinal Fusion and Bone Healing Enhancement Products 10/24/25 12/8/25 Pending Spinal Fusion and Bone Healing Enhancement Products
2025-UHC-217 Omnibus Codes 10/24/25 12/8/25 Pending Omnibus Codes
2025-UHC-786 Light and Laser Therapy 10/24/25 12/8/25 Pending Light and Laser Therapy
2025-UHC-1404 Breast Imaging for Screening and Diagnosing Cancer 10/24/25 12/8/25 Pending Breast Imaging for Screening and Diagnosing Cancer
2025-ACLA-1442 ACLA Prior Authorization Service List 10/24/25 12/8/25 Pending ACLA Prior Authorization Service List
2025-LHCC-1918 Diabetes Self-Management Training 10/24/25 12/8/25 Pending Diabetes Self-Management Training
2025-UHC-2757 Inhaled Nitric Oxide Therapy 10/24/25 12/8/25 Pending Inhaled Nitric Oxide Therapy
2025-LHCC-966 Cultural and Linguistic Policy 10/15/25 11/29/25 Pending Cultural and Linguistic Policy
2025-HUM-1460 Doula Services (ILO) 10/15/25 11/29/25 Pending Doula Services (ILO)
2025-ABH-2363 AMA XXXX Hospice 10/15/25 11/29/25 Pending AMA XXXX Hospice
2025-HBL-2748 Carelon Trans to Vsclr Emblztn-Occlsn Prcdrs 10/15/25 11/29/25 Pending Carelon Trans to Vsclr Emblztn-Occlsn Prcdrs
2025-HBL-1033 Therapeutic Apheresis 10/10/25 11/24/25 Pending Therapeutic Apheresis
2025-UHC-1123 Extracorporeal Shock Wave Therapy (ESWT) for Musculoskeletal Conditions and Soft Tissue Wounds 10/10/25 11/24/25 Pending Extracorporeal Shock Wave Therapy (ESWT) for Musculoskeletal Conditions and Soft Tissue Wounds
2025-UHC-1589 Surgical Treatment of Lymphedema 10/10/25 11/24/25 Pending Surgical Treatment of Lymphedema
2025-UHC-1762 Stereotactic Body Radiation Therapy and Stereotactic Radiosurgery 10/10/25 11/24/25 Pending Stereotactic Body Radiation Therapy and Stereotactic Radiosurgery
2025-UHC-486 Abnormal Uterine Bleeding and Uterine Fibroids 10/6/25 11/20/25 Pending Abnormal Uterine Bleeding and Uterine Fibroids
2025-UHC-793 Virtual Upper Gastrointestinal Endoscopy 10/6/25 11/20/25 Pending Virtual Upper Gastrointestinal Endoscopy
2025-LHCC-1273 Orthognathic Surgery 10/6/25 11/20/25 Pending Orthognathic Surgery
2025-LHCC-1277 Panniculectomy 10/6/25 11/20/25 Pending Panniculectomy
2025-LHCC-1361 Pediatric Heart Transplant 10/6/25 11/20/25 Pending Pediatric Heart Transplant
2025-LHCC-1741 AHCT for Sickle Cell Anemia and Thalassemia 10/6/25 11/20/25 Pending AHCT for Sickle Cell Anemia and Thalassemia
2025-LHCC-1842 Cosmetic and Reconstructive Procedures 10/6/25 11/20/25 Pending Cosmetic and Reconstructive Procedures
2025-UHC-2311 Injectable Dermal Fillers and Bulking Agents 10/6/25 11/20/25 Pending Injectable Dermal Fillers and Bulking Agents
2025-LHCC-2749 Radiation Therapy for Skin Cancer 10/6/25 11/20/25 Pending Radiation Therapy for Skin Cancer
2025-LHCC-1743 Hospice Services 9/29/25 11/13/25 Pending Hospice Services
2025-LHCC-1959 BH Treatment Documentation Requirements 9/29/25 11/13/25 Pending BH Treatment Documentation Requirements
2025-ABH-2536 Community Brief Crisis Support (CBCS) and Behavioral Health Crisis Care (BHCC) Policy 9/29/25 11/13/25 Pending Community Brief Crisis Support (CBCS) and Behavioral Health Crisis Care (BHCC) Policy
2025-ABH-822 ABH Provider Manual 9/29/25 11/13/25 Pending ABH Provider Manual
2025-ABH-1891 Member Appeals 9/29/25 11/13/25 Pending Member Appeals
2025-ABH-1892 Member Grievance 9/29/25 11/13/25 Pending Member Grievance
2025-LHCC-2476 In Lieu Of Services  Remote Patient Monitoring 9/29/25 11/13/25 Pending In Lieu Of Services  Remote Patient Monitoring
2025-LHCC-1491 NCCI Unbunding 9/29/25 11/13/25 Pending NCCI Unbunding
2025-LHCC-2530 Transportation Policy 9/29/25 11/13/25 Pending Transportation Policy
2025-LHCC-687 Measurable Progressive Improvement 9/29/25 11/13/25 Pending Measurable Progressive Improvement
2025-LHCC-931 Appeals Process 9/29/25 11/13/25 Pending Appeals Process
2025-LHCC-1378 Wheelchair Seating 9/29/25 11/13/25 Pending Wheelchair Seating
2025-LHCC-1410 Neurofeedback for Behavioral Health Disorders 9/29/25 11/13/25 Pending Neurofeedback for Behavioral Health Disorders
2025-LHCC-1480 Pre-operative Visits 9/29/25 11/13/25 Pending Pre-operative Visits
2025-LHCC-1908 Community Brief Crisis Support 9/29/25 11/13/25 Pending Community Brief Crisis Support
2025-HUM-1922 UM Home Health Clinical Coverage Policy 9/29/25 11/13/25 Pending UM Home Health Clinical Coverage Policy
2025-ABH-2254 Benefit Exception Amendment 9/29/25 11/13/25 Pending Benefit Exception Amendment
2025-HUM-2565 Drugs and Biologicals HCPCS 9/29/25 11/13/25 Pending Drugs and Biologicals HCPCS
2025-LHCC-2667 MediTrans Claims Manual9/29/25 9/29/25 11/13/25 Pending MediTrans Claims Manual
2025-ACLA-2727 MH-IOP 9/29/25 11/13/25 Pending MH-IOP
2025-HUM-2728 Correct Coding 9/29/25 11/13/25 Pending Correct Coding
2025-HUM-2729 Correct Coding 9/29/25 11/13/25 Pending Correct Coding
2025-HUM-2740 Anesthesia 9/29/25 11/13/25 Pending Anesthesia
2025-LHCC-1507 Clinical Validation of Modifier 59 9/19/25 11/3/25 Pending Clinical Validation of Modifier 59
2025-LHCC-1509 Clinical Validation of Modifier 25 9/19/25 11/3/25 Pending Clinical Validation of Modifier 25
2025-HUM-1644 Eyebrow and Eyelid Repair 9/19/25 11/3/25 Pending Eyebrow and Eyelid Repair
2025-HUM-1661 Molecular Diagnostic Assays and Breath Testing for Transplant Rejection Clinical Coverage Policy 9/19/25 11/3/25 Pending Molecular Diagnostic Assays and Breath Testing for Transplant Rejection Clinical Coverage Policy

RELATED INFO

Surgeon General Ralph L. Abraham, M.D.

Secretary Bruce D. Greenstein

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