Louisiana Administrative Code
Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE
Part XV - Services for Special Populations
Subpart 19 - Pediatric Day Health Care Program
Chapter 277 - Services
Section XV-27701 - Service Coverage and Limitations

Universal Citation: LA Admin Code XV-27701

Current through Register Vol. 50, No. 9, September 20, 2024

A. The Medicaid Program will reimburse a pediatric day health care facility for the following covered services:

1. nursing care;

2. respiratory care;

3. physical therapy;

4. speech-language therapy;

5. occupational therapy;

6. social services;

7. personal care services;

8. transportation to and from the PDHC facility; and

9. one or more meals and snacks per day depending on the child's length of stay.

B. Non-Covered Services. The following services do not qualify as covered PDHC services:

1. education and training services;

2. before and after school care;

3. medical equipment, supplies and appliances;

4. parenteral or enteral nutrition; or

5. infant food or formula.

C. PDHC facility services must be prescribed by the recipient's prescribing physician and an individualized plan of care must be developed for the recipient by the PDHC facility.

D. PDHC services must be prior authorized by the Medicaid Program or its approved designee. Services provided without authorization shall not be considered for reimbursement, except in the case of retroactive Medicaid eligibility.

E. Service Limitations. Services may be provided seven days per week and up to 12 hours per day for qualified Medicaid recipients as documented in the plan of care.

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX 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.
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