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. 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
2024-LDH-8 MCO Manual > Part 4: Services > Pharmacy > Lock-In Program 5/16/24 6/30/24 Pending Lock-In Program
2024-LDH-9 MCO Manual > Part 10: Provider Services > Provider Issue Resolution>Provider Issue Escalation and Resolution 5/16/24 6/30/24 Pending Provider Issue Resolution
2024-LDH-10 MCO Manual > Part 4: Services > In Lieu of Services > Behavioral Health Services > Visions of Hope Community Services 5/16/24 6/30/24 Pending Visions of Hope ILOS
2024-LHCC-111 Functional Family Therapy - Child Welfare 5/9/24 6/23/24 Pending Functional Family Therapy - Child Welfare
2024-UHC-217 Omnibus Codes 5/9/24 6/23/24 Pending Omnibus Codes
2024-UHC-492 Surgical and Ablative Procedures for Venous Insufficiency and Varicose Veins 5/9/24 6/23/24 Pending Surgical and Ablative Procedures for Venous Insufficiency and Varicose Veins
2024-UHC-555 Orthognathic (Jaw) Surgery 5/9/24 6/23/24 Pending Orthognathic (Jaw) Surgery
2024-UHC-825 Cardiac Event Monitoring 5/9/24 6/23/24 Pending Cardiac Event Monitoring
2024-LHCC-982 Outpatient Applied Behavior Analysis Medical Necessity 5/9/24 6/23/24 Pending Outpatient Applied Behavior Analysis Medical Necessity
2024-HBL-1208 Cosmetic and Reconstr Serv of Trunk and Groin 5/9/24 6/23/24 Pending Cosmetic and Reconstr Serv of Trunk and Groin
2024-LHCC-1216 Bariatric Surgery 5/9/24 6/23/24 Pending Bariatric Surgery
2024-HBL-1301 Sacroilac Joint Fusion 5/9/24 6/23/24 Pending Sacroilac Joint Fusion
2024-UHC-1432 Pediatric Gait Trainers and Standing Systems 5/9/24 6/23/24 Pending Pediatric Gait Trainers and Standing Systems
2024-UHC-1523 Facet Joint and Medial Branch Block Injections for Spinal Pain 5/9/24 6/23/24 Pending Facet Joint and Medial Branch Block Injections for Spinal Pain
2024-HBL-1778 Outpatient Glycated Hemoglobin and Protein Testing 5/9/24 6/23/24 Pending Outpatient Glycated Hemoglobin and Protein Testing
2024-UHC-1848 Mobility Devices, Options and Accessories 5/9/24 6/23/24 Pending Mobility Devices, Options and Accessories
2024-LHCC-1907 Hyperhidrousis Treatments 5/9/24 6/23/24 Pending Hyperhidrousis Treatments
2024-LHCC-1919 Cardiovascular Services 5/9/24 6/23/24 Pending Cardiovascular Services
2024-LHCC-2153 Pharmacy Lock-In Program 5/9/24 6/23/24 Pending Pharmacy Lock-In Program
2024-ABH-2382 Utilization Management System Controls 5/9/24 6/23/24 Pending Utilization Management System Controls
2024-ABH-2390 Chiropractic In Lieu of Services ILO 5/9/24 6/23/24 Pending Chiropractic In Lieu of Services ILO
2024-ABH-2391 Gender Affirming Care Policy 5/9/24 6/23/24 Pending Gender Affirming Care Policy
2024-HBL-2392 Wireless Cap for the Eval of Suspect Gastric Intestinal Motility Dis 5/9/24 6/23/24 Pending Wireless Cap for the Eval of Suspect Gastric Intestinal Motility Dis
2024-HBL-2395 External Insulin Pumps 5/9/24 6/23/24 Pending External Insulin Pumps
2024-HBL-2396 Vestibular Function Testing 5/9/24 6/23/24 Pending Vestibular Function Testing
2024-UHC-222 Skin and Soft Tissue Substitutes 4/30/24 6/14/24 Pending Skin and Soft Tissue Substitutes
2024-HBL-1058 Whole Genome Sequ. Whole Exome Sequ. Gene Panels and Molecular Prof 4/30/24 6/14/24 Pending Whole Genome Sequ. Whole Exome Sequ. Gene Panels and Molecular Prof
2024-LHCC-1190 PCP Auto-Assignment PP 4/30/24 6/14/24 Pending PCP Auto-Assignment PP
2024-HBL-1222 Mandibular/Maxillary (Orthognathic) Surgery 4/30/24 6/14/24 Pending Mandibular/Maxillary (Orthognathic) Surgery
2024-HBL-1245 Myoelectric Upper Extremity Prosthetic Devices 4/30/24 6/14/24 Pending Myoelectric Upper Extremity Prosthetic Devices
2024-HBL-1257 Compression Devices for Lymphedema 4/30/24 6/14/24 Pending Compression Devices for Lymphedema
2024-HUM-1428 Preauthorization and Notification List 4/30/24 6/14/24 Pending Preauthorization and Notification List
2024-HUM-1826 Revenue Codes for Outpatient Services 4/30/24 6/14/24 Pending Revenue Codes for Outpatient Services
2024-ABH-1900 Physical Safety for Field Based Colleagues 4/30/24 6/14/24 Pending Physical Safety for Field Based Colleagues
2024-UHC-1928 Transanal Endoscopic Microsurgery 4/30/24 6/14/24 Pending Transanal Endoscopic Microsurgery
2024-LHCC-1938 Continuity & Coordination Between Medical and Behavioral Health Care 4/30/24 6/14/24 Pending Continuity & Coordination Between Medical and Behavioral Health Care
2024-UHC-2277 Risk Strat NCM 012 4/30/24 6/14/24 Pending Risk Strat NCM 012
2024-ABH-2366 AMA XXXX Supplement Oxygen and Oxygen Supplies 4/30/24 6/14/24 Pending AMA XXXX Supplement Oxygen and Oxygen Supplies
2024-LHCC-2372 Member Reassignment 4/30/24 6/14/24 Pending Member Reassignment
2024-LHCC-2373 Provider Facing Policy for Member Moves 4/30/24 6/14/24 Pending Provider Facing Policy for Member Moves
2024-ABH-2376 Concurrent Review Observation Care 4/30/24 6/14/24 Pending Concurrent Review Observation Care
2024-ABH-2377 Common Hospital Observation 4/30/24 6/14/24 Pending Common Hospital Observation
2024-ABH-2385 UB 04 Reminder 4/30/24 6/14/24 Pending UB 04 Reminder
2024-ABH-2387 Biological Safety for Field Based Colleagues 4/30/24 6/14/24 Pending Biological Safety for Field Based Colleagues
2024-HBL-2388 Sacral Nerve Stim and Percut or Implant Tib Nerve Stim Urin and Fecal Incont Urin Ret 4/30/24 6/14/24 Pending Sacral Nerve Stim and Percut or Implant Tib Nerve Stim Urin and Fecal Incont Urin Ret
2024-ACLA-268 Care and BH Providers 4/16/24 5/31/24 Pending Care and BH Providers
2024-LHCC-423 EPSDT 4/16/24 5/31/24 Pending EPSDT
2024-UHC-474 Rhinoplasty and Other Nasal Procedures 4/16/24 5/31/24 Pending Rhinoplasty and Other Nasal Procedures
2024-UHC-490 Cardiovascular Disease Risk Tests 4/16/24 5/31/24 Pending Cardiovascular Disease Risk Tests
2024-UHC-785 Hearing Aids and Devices including wearable, bone-anchored and semi-implantable 4/16/24 5/31/24 Pending Hearing Aids and Devices including wearable, bone-anchored and semi-implantable
2024-UHC-1170 Prostate Surgeries and Interventions 4/16/24 5/31/24 Pending Prostate Surgeries and Interventions
2024-ACLA-1183 Personal Care Services 4/16/24 5/31/24 Pending Personal Care Services
2024-LHCC-1275 Oxygen Use and Concentrators 4/16/24 5/31/24 Pending Oxygen Use and Concentrators
2024-UHC-1394 Transpupillary Thermotherapy 4/16/24 5/31/24 Pending Transpupillary Thermotherapy
2024-HUM-1668 Wheelchair, Wheelchair repairs, Standing Frame, and Patient Lifts Clinical Coverage Policy 4/16/24 5/31/24 Pending Wheelchair, Wheelchair repairs, Standing Frame, and Patient Lifts Clinical Coverage Policy
2024-LHCC-1913 Pharmacy Claims Processing 4/16/24 5/31/24 Pending Pharmacy Claims Processing
2024-LHCC-2321 Pharmacy Program 4/16/24 5/31/24 Pending Pharmacy Program
2024-ABH-2362 AMA XXXX Home Health and Extended Home Health 4/16/24 5/31/24 Pending AMA XXXX Home Health and Extended Home Health
2024-ABH-2363 AMA XXXX Hospice 4/16/24 5/31/24 Pending AMA XXXX Hospice
2024-ABH-2370 Dynamo Web Portals Data Security Breach Notification Amend 4/16/24 5/31/24 Pending Dynamo Web Portals Data Security Breach Notification Amend
2024-HUM-2371 Lactation Support Policy 4/16/24 5/31/24 Pending Lactation Support Policy
2024-UHC-2374 LA New Housecalls 4/16/24 5/31/24 Pending LA New Housecalls
2024-LDH-7 MCO Manual > Part 4: Services > Pharmacy > Preferred Drug List 4/11/24 5/26/24 Pending Preferred Drug List
2024-LDH-6 MCO Manual > Part 4: Services > MCO Covered Services > Behavioral Health Services 4/11/24 5/26/24 Pending Behavioral Health Covered Services
2024-LDH-5 MCO Manual > Part 8: Encounters 4/11/24 5/26/24 Pending Split-Billing for Encounters
2024-LDH-4 MCO Manual > Part 13: Quality > Performance Improvement Projects 4/11/24 5/26/24 Pending Quality Performance Improvement Projects
2024-LDH-3 MCO Manual > Part 13: Quality > Performance Improvement Projects > Quality Monitoring Reviews for Behavioral Health Providers 4/11/24 5/26/24 Pending Quality Monitoring Reviews for Behavioral Health Providers
2024-LDH-2 MCO Manual > Part 4: Services > Pharmacy 4/11/24 5/26/24 Pending Pharmacy
2024-LDH-1 MCO Manual > Part 9: Provider Network > Primary Care >Enrollee Reassignment Policy 4/11/24 5/26/24 Pending Enrollee Reassignment Policy
2024-HBL-2344 Leadless Pacemaker 4/2/24 5/17/24 Pending Leadless Pacemaker
2024-ABH-2360 AMA XXXX Enteral Nutrition and Infusion Pump 4/2/24 5/17/24 Pending AMA XXXX Enteral Nutrition and Infusion Pump
2024-ABH-2364 AMA XXXX Hospital Bed Mattress and Lift 4/2/24 5/17/24 Pending AMA XXXX Hospital Bed Mattress and Lift
2024-HBL-811 Locoregional Techniques for Treating Primary and Metastatic Liver Malignancies 4/2/24 5/17/24 Pending Locoregional Techniques for Treating Primary and Metastatic Liver Malignancies
2024-UHC-949 Chemotherapy-Observation or Inpatient Hospitalization 4/2/24 5/17/24 Pending Chemotherapy-Observation or Inpatient Hospitalization
2024-ABH-953 Multi-Systemic Therapy (MST) 4/2/24 5/17/24 Pending Multi-Systemic Therapy (MST)
2024-ABH-954 Community Psychiatric Support and Treatment (CPST) and Psychosocial Rehabilitation (PSR) 4/2/24 5/17/24 Pending Community Psychiatric Support and Treatment (CPST) and Psychosocial Rehabilitation (PSR)
2024-ABH-955 Crisis Intervention (CI) Services 4/2/24 5/17/24 Pending Crisis Intervention (CI) Services
2024-LHCC-1214 Total Parenteral Nutrition and Intradialytic Parental Nutrition 4/2/24 5/17/24 Pending Total Parenteral Nutrition and Intradialytic Parental Nutrition
2024-LHCC-1218 Ventricular Assist Devices 4/2/24 5/17/24 Pending Ventricular Assist Devices
2024-LHCC-1353 Articular Cartilage Defect Repairs 4/2/24 5/17/24 Pending Articular Cartilage Defect Repairs
2024-LHCC-1355 Functional MRI 4/2/24 5/17/24 Pending Functional MRI
2024-LHCC-1358 Pancreas Transplantation 4/2/24 5/17/24 Pending Pancreas Transplantation
2024-LHCC-1360 Heart-Lung Transplant 4/2/24 5/17/24 Pending Heart-Lung Transplant
2024-LHCC-1362 Nonmyeloablative allogeneric SCT 4/2/24 5/17/24 Pending Nonmyeloablative allogeneric SCT
2024-LHCC-1363 Tandem Transplant 4/2/24 5/17/24 Pending Tandem Transplant
2024-LHCC-1410 Neurofeedback for Behavioral Health Disorders 4/2/24 5/17/24 Pending Neurofeedback for Behavioral Health Disorders
2024-ABH-1528 Substance Use Disorder Treatment - Intensive Outpatient and Residential LOC 4/2/24 5/17/24 Pending Substance Use Disorder Treatment - Intensive Outpatient and Residential LOC
2024-LHCC-1837 Obstetrical Home Care Programs 4/2/24 5/17/24 Pending Obstetrical Home Care Programs
2024-LHCC-1934 Experimental Technologies 4/2/24 5/17/24 Pending Experimental Technologies
2024-LHCC-1935 Gastric Electrical Stimulation 4/2/24 5/17/24 Pending Gastric Electrical Stimulation
2024-LHCC-2225 Lantidra (donislecel) Allogeneic Pancreatic Islet Cellular Therapy 4/2/24 5/17/24 Pending Lantidra (donislecel) Allogeneic Pancreatic Islet Cellular Therapy
2024-ACLA-2318 Peer Support Services 4/2/24 5/17/24 Pending Peer Support Services

RELATED INFO