Louisiana Administrative Code
Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE
Part III - Eligibility
Subpart 11 - State Children's Health Insurance Program
Chapter 205 - Louisiana Children's Health Insurance Program (LaCHIP)-Phase V
Section III-20505 - Covered Services
Universal Citation: LA Admin Code III-20505
Current through Register Vol. 50, No. 9, September 20, 2024
A. Children covered in phase five of the LaCHIP expansion shall receive health care benefits through an array of covered services offered by health plans participating in the BAYOU HEALTH Program, and behavioral health services administered by the statewide management organization under the LBHP. The following services shall be included:
1.
inpatient hospital services:
a.
pre-certification is required for hospital admissions. Emergency services are
covered if, upon review, presentation is determined to be life-threatening,
resulting in admission to inpatient, partial hospital or intensive outpatient
level of care;
2.
outpatient hospital services:
a. the relative
therapies require pre-certification;
3. physician services;
4. surgical procedures;
5. clinic services and other ambulatory
health care services;
6.
prescription drugs;
7. laboratory
and radiological services;
8.
pre-natal care and pre-pregnancy family services and supplies;
9. inpatient and outpatient behavioral health
services other than those listed in any other provisions of §20503:
a. these services include those furnished in
a state-operated mental hospital, residential facility or other 24 hour
therapeutically-planned structural services. Pre-certification is required for
these services. Emergency services are covered if, upon review, presentation is
determined to be life-threatening, resulting in admission to inpatient, partial
hospital or intensive outpatient level of care;
b. inpatient and outpatient visits are
limited to medically necessary services not to exceed a combined 52 visits per
plan year for mental health and substance abuse services;
10. durable medical equipment;
11. nursing care services;
a. Repealed.
12. dental services;
13. inpatient substance abuse treatment
services, including residential substance abuse treatment services:
a. inpatient admissions must be
pre-certified. Emergency services are covered if, upon review, presentation is
determined to be life-threatening, resulting in admission to inpatient, partial
hospital or intensive outpatient level of care;
b. inpatient days are limited to medically
necessary services not to exceed a combined 45 visits per plan year for mental
health and substance abuse services;
14. outpatient substance abuse treatment
services:
a. all services must be
pre-certified;
b. outpatient visits
are limited to medically necessary services not to exceed a combined 52 visits
per plan year for mental health and substance abuse services;
15. case management services;
a. Repealed.
16. physical therapy, occupational therapy
and services for individuals with speech, hearing and language disorders:
a. physical and occupational therapy is
limited to 50 visits per year and speech therapy is limited to 26 visits per
year;
17. hospice care:
a. Repealed.
18. medical transportation; and
a. Repealed.
19. any other medically necessary medical,
diagnostic, screening, preventive, restorative, remedial, therapeutic or
rehabilitative services.
AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XXI of the Social Security Act.
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.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.
