Louisiana Administrative Code
Title 48 - PUBLIC HEALTH-GENERAL
Part V - Child Welfare
Subpart 17 - Children's Special Health Services (CSHS)
Chapter 55 - Congenital Anomalies and Spinal Cord Dysfunctions
Section V-5511 - Requests for Out of State Hospitalization

Universal Citation: LA Admin Code V-5511

Current through Register Vol. 50, No. 12, December 20, 2024

A. CSHS does not pay for services provided outside of Louisiana except for cases of extraordinary need. Requests for out of state services must be approved by the CSHS Administrative Unit and will be considered only under the following circumstances:

1. the service is not available in Louisiana, and

2. the patient's condition is such that it can not be treated adequately by any other means available in Louisiana; and

3. the patient's condition is of such a serious nature that treatment is justified; and

4. the service is requested by a CSHS attending physician; and

5. No other funding source is available for the requested service.

B. The request must be made in writing, initiated by a CSHS attending physician and supported by a second CSHS attending physician. Circumstances 1-3 must be verified in writing by both physicians. CSHS Regional Office Staff of the patient's region of residence must forward this documentation to the CSHS Central Office along with copies of the following:

1. evidence of CSHS eligibility

2. evidence that there is no other funding source available

3. medical records

4. written documentation of the arrangements made for the requested service with the out-of-state hospital, physician(s), laboratory(ies), and any other vendors who will be submitting bills to CSHS, and

5. transportation and related expenses.

B. A decision will be made on a case by case basis by the CSHS Administrative Unit depending on availability of funds. The CSHS Regional Office of the patient's region of residence will be notified in writing of the disposition of the request. CSHS will reimburse all vendors at the Medicaid rate of the State in which the service is provided. It is the responsibility of the CSHS Regional Staff to obtain this rate and acceptance by the out-of-state providers.

AUTHORITY NOTE: Promulgated in accordance with R.S. 40:31.2, and R.S. 40:1299.111-120.

Disclaimer: These regulations may not be the most recent version. Louisiana may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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