Louisiana Administrative Code
Title 40 - LABOR AND EMPLOYMENT
Part I - Workers' Compensation Administration
Subpart 2 - Medical Guidelines
Chapter 51 - Medical Reimbursement Schedule
Section I-5109 - Prior Authorization
Current through Register Vol. 50, No. 9, September 20, 2024
A. The Louisiana Workers' Compensation Statutes (R.S. 23:1142) establishes a monetary limit for nonemergency medical care. The statute further provides significant penalties for a carrier/self-insured employer's arbitrary and capricious refusal to approve necessary care beyond that limit. (See Chapter 27 Utilization Review Procedu§2715. A and B). In addition to all other rules and procedures, the provider or practitioner who provide care under the "medical emergency" exception must demonstrate that it was a "medical emergency" as outlined in the Utilization Review Procedures, cited above. For additional instructions, please refer to the respective section of the schedule.
In addition, the following Sections of this Chapter are applicable and shall be used for the other chapters in this Part governing reimbursement. These specific Chapters are: Chapter 31, Vision Care Services; Chapter 33, Hearing Aid Equipment and Services; Chapter 35, Nursing Attendant Care and Home Health Services; Chapter 39, Medical Transportation; Chapter 41, Durable Medical Equipment and Supplies; Chapter 43, Prosthetic and Orthopedic Equipment; Chapter 45, Respiratory Services; Chapter 47, Miscellaneous Claimant Expenses; and Chapter 49, Vocational Rehabilitation Consultant.
AUTHORITY NOTE: Promulgated in accordance with R.S. 23:1034.2.
