Medicaid Managed Care Policies & Procedures Archive (2019)

"Policy or procedure" 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.

Below are items previously posted for public comment in 2019:

Item Number	Policy/Procedure	Date Posted	Comment Period Closed	Status	Document Links
2019-LHCC-45	Court Ordered Services	12/27/19	2/10/20	Approved	Court Ordered Services
2019-LHCC-48	EPSDT Personal Care Services	12/26/19	2/9/20	Approved	EPSDT Personal Care Services
2019-UHC-200	Ablative Treatment for Spinal Pain (for Louisiana Only)	12/23/19	2/6/20	Completed	Ablative Treatment for Spinal Pain (for Louisiana Only)
2019-UHC-201	Apheresis (for Louisiana Only)	12/23/19	2/6/20	Completed	Apheresis (for Louisiana Only)
2019-UHC-202	Balloon Sinus Ostial Dilation (for Louisiana Only)	12/23/19	2/6/20	Completed	Balloon Sinus Ostial Dilation (for Louisiana Only)
2019-UHC-203	Breast Reduction Surgery (for Louisiana Only)	12/23/19	2/6/20	Pending	Breast Reduction Surgery (for Louisiana Only)
2019-UHC-204	Cardiac Event Monitoring	12/23/19	2/6/20	Completed	Cardiac Event Monitoring
2019-UHC-205	Computed Tomographic Colonography	12/23/19	2/6/20	Completed	Computed Tomographic Colonography
2019-UHC-206	Electric Tumor Treatment Field Therapy	12/23/19	2/6/20	Completed	Electric Tumor Treatment Field Therapy
2019-UHC-207	Electrical Stimulation for the Treatment of Pain and Muscle Rehabilitation	12/23/19	2/6/20	Completed	Electrical Stimulation for the Treatment of Pain and Muscle Rehabilitation
2019-UHC-208	Epidural Steroid and Facet Injections for Spinal Pain	12/23/19	2/6/20	Completed	Epidural Steroid and Facet Injections for Spinal Pain
2019-UHC-210	Epiduroscopy, Epidural Lysis of Adhesions and Functional Anesthetic Discography (for Louisiana Only)	12/23/19	2/6/20	Completed	Epiduroscopy, Epidural Lysis of Adhesions and Functional Anesthetic Discography (for Louisiana Only)
2019-UHC-211	Fecal Calprotectin Testing (for Louisiana Only)	12/23/19	2/6/20	Completed	Fecal Calprotectin Testing (for Louisiana Only)
2019-UHC-212	Functional Endoscopic Sinus Surgery (FESS) (for Louisiana Only)	12/23/19	2/6/20	Completed	Functional Endoscopic Sinus Surgery (FESS) (for Louisiana Only)
2019-UHC-213	Genetic Testing for Hereditary Cancer (for Louisiana Only)	12/23/19	2/6/20	Completed	Genetic Testing for Hereditary Cancer (for Louisiana Only)
2019-UHC-214	Molecular Oncology Testing for Cancer Diagnosis, Prognosis, and Treatment Decisions (for Louisiana Only)	12/23/19	2/6/20	Completed	Molecular Oncology Testing for Cancer Diagnosis, Prognosis, and Treatment Decisions (for Louisiana Only)
2019-UHC-215	Bone or Soft Tissue Healing and Fusion Enhancement Products	12/23/19	2/6/20	Completed	Bone or Soft Tissue Healing and Fusion Enhancement Products
2019-UHC-216	DME	12/23/19	2/6/20	Completed	DME
2019-UHC-217	Omnibus Codes	12/23/19	2/6/20	Completed	Omnibus Codes
2019-UHC-218	Pharmacogenetic Testing	12/23/19	2/6/20	Completed	Pharmacogenetic Testing
2019-UHC-219	Articular Defect Repairs	12/23/19	2/6/20	Completed	Articular Defect Repairs
2019-UHC-220	Prolotherapy and Platelet Rich Plasma Therapies	12/23/19	2/6/20	Completed	Prolotherapy and Platelet Rich Plasma Therapies
2019-UHC-221	Prosthetic Devices, Specialized, Microprocessor or Myoelectric Limbs	12/23/19	2/6/20	Completed	Prosthetic Devices, Specialized, Microprocessor or Myoelectric Limbs
2019-UHC-222	Skin and Soft Tissue Substitutes (for Louisiana Only)	12/23/19	2/6/20	Completed	Skin and Soft Tissue Substitutes (for Louisiana Only)
2019-UHC-223	Vagus and Trigeminal Nerve Stimulation	12/23/19	2/6/20	Completed	Vagus and Trigeminal Nerve Stimulation
2019-UHC-224	Visual Information Processing Evaluation and Orthoptic and Vision Therapy	12/23/19	2/6/20	Completed	Visual Information Processing Evaluation and Orthoptic and Vision Therapy
2019-UHC-247	Negative Pressure Wound Therapy	12/23/19	2/6/20	Completed	Negative Pressure Wound Therapy
2019-LHCC-138	Appropriate UM Professionals	12/27/19	2/10/20	Approved	Appropriate UM Professionals
2019-LHCC-139	UM Program Description	12/27/19	2/10/20	Approved	UM Program Description
2019-ABH-118	Prior Authorization of PDHC	12/18/19	2/1/20	Approved	Prior Authorization of PDHC
2019-ABH-117	Multi-Systemic Therapy	12/18/19	2/1/20	Approved	Multi-Systemic Therapy
2019-ABH-116	Crisis Intervention Services	12/18/19	2/1/20	Approved	Crisis Intervention Services
2019-HBL-128	Continuing Crisis Intervention Services	12/18/19	2/1/20	Approved	Continuing Crisis Intervention Services
2019-UHC-125	Certification of Need for PRTFs	12/16/19	1/30/20	Approved	Certification of Need for PRTFs
2019-PHARM-3	Mayzent	12/12/19	1/26/20	Approved	Mayzent
2019-PHARM-4	Reclast	12/12/19	1/26/20	Approved	Reclast
2019-PHARM-5	Vyndaquel Criteria	12/12/19	1/26/20	Approved	Vyndaquel Criteria
2019-PHARM-6	Spinraza PA Form	12/12/19	1/26/20	Approved	Spinraza PA Form
2019-PHARM-7	Rinvoq	12/12/19	1/26/20	Approved	Rinvoq
2019-PHARM-8	Pamidronate Disodium	12/12/19	1/26/20	Approved	Pamidronate Disodium
2019-PHARM-9	Neudexta	12/12/19	1/26/20	Approved	Neudexta
2019-PHARM-10	Gattex	12/12/19	1/26/20	Approved	Gattex
2019-PHARM-11	Epidiolex	12/12/19	1/26/20	Approved	Epidiolex
2019-PHARM-12	Enzyme Replacement Therapy	12/12/19	1/26/20	Approved	Enzyme Replacement Therapy
2019-PHARM-13	Cablivi Criteria	12/12/19	1/26/20	Approved	Cablivi Criteria
2019-PHARM-14	Acthar Gel Criteria	12/12/19	1/26/20	Approved	Acthar Gel Criteria
2019-PHARM-16	Nucala	12/12/19	1/26/20	Approved	Nucala
2019-PHARM-17	POS Posting for November 2019 DUR	12/12/19	1/26/20	Approved	POS Posting for November 2019 DUR
2019-ABH-122	Out of State Outpatient CCR	12/11/19	1/25/20	Approved	Out of State Outpatient CCR
2019-UHC-123	Prior Authorization FAQ 2019	12/11/19	1/25/20	Approved	Prior Authorization FAQ 2019
2019-LHCC-111	Functional Family Therapy – Child Welfare	12/11/19	1/25/20	Approved	Functional Family Therapy – Child Welfare
2019-HBL-142	Med CAT II Changes Provider Letter	12/11/19	1/25/20	Approved	Med CAT II Changes Provider Letter
2019-UHC-124	Intensive Outpatient Process Change Proposal	12/11/19	1/25/20	Approved	Intensive Outpatient Process Change Proposal
2019-HBL-229	Special Health Care Needs Population	12/6/19	1/20/20	Approved	Special Health Care Needs Population
2019-LHCC-134	ED Diversion PP	12/6/19	1/20/20	Approved	ED Diversion PP
2019-LHCC-136	Oversight of Delegated UM	12/6/19	1/20/20	Approved	Oversight of Delegated UM
2019-LHCC-137	UM Communication Services	12/6/19	1/20/20	Approved	UM Communication Services
2019-LHCC-140	Timeliness of UM Decisions	12/6/19	1/20/20	Approved	Timeliness of UM Decisions
2019-LHCC-141	Enteral and Oral Nutrition	12/6/19	1/20/20	Approved	Enteral and Oral Nutrition
2019-HBL-228	Informal Reconsideration	12/5/19	1/19/20	Completed	Informal Reconsideration
2019-HBL-240	Appeal Policy Provider Manual Updates	12/5/19	1/19/20	Approved	Appeal Policy Provider Manual Updates
2019-LHCC-40	Provider policy revisions - Provider Orientation	12/5/19	1/19/20	Completed	Provider policy revisions - Provider Orientation
2019-LHCC-41	Provider policy revisions - Provider Visit Schedule	12/5/19	1/19/20	Completed	Provider policy revisions - Provider Visit Schedule
2019-LHCC-43	Quality Policy revisions - Appeals Process	12/5/19	1/19/20	Completed	Quality Policy revisions - Appeals Process
2019-LHCC-47	Clinical policy revision requests - Authorization for Second Clinical Opinions	12/5/19	1/19/20	Completed	Clinical policy revision requests - Authorization for Second Clinical Opinions
2019-LHCC-55	LHCC revisions to Operations policies - Call Line PP Provider Services Calls Hotline	12/5/19	1/19/20	Completed	LHCC revisions to Operations policies - Call Line PP Provider Services Calls Hotline
2019-LHCC-105	Appeal of UM Decisions	12/5/19	1/19/20	Completed	Appeal of UM Decisions
2019-LHCC-108	Womens Health Services	12/5/19	1/19/20	Completed	Womens Health Services
2019-LHCC-109	Clinical Decision Criteria and Application	12/5/19	1/19/20	Completed	Clinical Decision Criteria and Application InterQual Corporate Policy Variances
2019-LHCC-110	Continued Stay and Discharge Planning	12/5/19	1/19/20	Completed	Continued Stay and Discharge Planning
2019-LHCC-133	Care Management Program Description	12/5/19	1/19/20	Approved	Care Management Program Description
2019-UHC-225	Radiology CPT Codes	12/5/19	1/19/20	Approved	Radiology CPT Codes
2019-UHC-238	Breast Reconstruction Not Following Mastectomy	12/5/19	1/19/20	Approved	Breast Reconstruction Not Following Mastectomy
2019-UHC-239	Breast Reconstruction Post Mastectomy	12/5/19	1/19/20	Approved	Breast Reconstruction Post Mastectomy
2019-HPA-4	Reimbursement of Opioid Use Disorder Treatment in Opioid Treatment Programs	11/26/19	1/10/20	Complete	HPA: Reimbursement of Opioid Use Disorder Treatment in Opioid Treatment Programs
2019-Enbrel-1	Recommendation to Change Status of Enbrel of Medicaid PDL	11/25/19	1/9/20	Approved	Recommendation to Change Status of Enbrel of Medicaid PDL
2019-HPA-3	Telemedicine/Telehealth Billing Changes for RHCs and FQHCs	11/25/19	1/10/20	Complete	HPA: Telemedicine/Telehealth Billing Changes for RHCs and FQHCs
2019-IB-1	Telemedicine/Telehealth Billing Changes for RHCs and FQHCs	11/25/19	1/10/20	Complete	IB: Telemedicine/Telehealth Billing Changes for RHCs and FQHCs
2019-HPA-2	CLIA Number Information: Revised	11/15/19	12/30/19	Complete	Revised HPA: CLIA Number Information
2019-Chisholm-1	Chisholm Compliance MCO User Process Manual	10/29/19	12/13/19	Complete	Chisholm Compliance MCO User Process Manual
2019-Healthy Blue-95	MHR PSR Provider Bulletin	10/24/19	12/8/19	Approved	MHR PSR Provider Bulletin
2019-LHCC-54	PCP Selection Change	10/14/19	11/28/19	Approved	PCP Selection Change
2019-PHARM-2	MCO Criteria Changes	10/13/19	11/27/19	Complete	MCO Criteria Changes
2019-LHCC-25	UM Communication Services	10/11/19	11/25/19	Approved	UM Communication Services
2019-Healthy Blue-49	PA Req N Supervision for Hyperbaric O2	10/11/19	11/25/19	Approved	PA Req N Supervision for Hyperbaric O2
2019-Healthy Blue-96	ICD-10 Coding Tips Sheet Flier	10/10/19	11/24/19	Approved	ICD-10 Coding Tips Sheet Flier
2019-Healthy Blue-80	SBIRT Filter Update	10/10/19	11/24/19	Approved	SBIRT Flier Update
2019 Healthy Blue-92	CCRT Configuration - PA Changes - Blue RFRF	10/10/19	11/24/19	Approved	CCRT Configuration - PA Changes - Blue RFRF
2019-Healthy Blue-94	SUD Criteria for Prior Authorization	10/10/19	11/24/19	Approved	SUD Criteria for Prior Authorization
2019-Healthy Blue-38	WAVE CG DME 46 Pneumatic	10/4/19	11/18/19	Approved	WAVE CG DME 46 Pneumatic
2019-PHARM-1	Suspending Agents	9/25/19	11/9/19	Approved	Suspending Agents
2019-PDL-1	Advair - PDL Changes	9/25/19	11/9/19	Pending	PDL Changes
2019-UHC-29	Pharmacogenetic Testing	9/20/19	11/4/19	Approved	Pharmacogenetic Testing
2019-UHC-27	UHC Prior Authorization LA Effective 9.1.19	9/13/19	10/28/19	Approved	UHC Prior Authorization LA Effective 9.1.19
2019-HBL-20	Semi Annual Cost of Care Review	9/13/19	10/28/19	Approved	BLA-NL-0148-19
2019-DUR-1	Pharmacy Drug Utilization Review (DUR) Criteria	9/13/19	10/28/19	Complete	Pharmacy DUR Criteria effective 11/1 and 12/1
2019-IB-1	Proposed retirement of Informational Bulletin 16-1	9/12/19	10/27/19	Complete	IB 16-1
2019-SCG-2	LDH stopped using self-reported data in 2018; the 416 reports are generated from MCO encounter data.	9/10/19	10/25/19	Complete	MCO System Companion Guide, pg. 117
2019-SCG-1	Edit 472 disposition to be changed from "E" to "D" [deny].	9/10/19	10/25/19	Complete	MCO System Companion Guide, pg. 128
2019-HPA-1	Severe Combined Immunodeficiency (SCID)	8/27/19	10/11/19	Complete	Severe Combined Immunodeficiency (SCID)

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