Louisiana Administrative Code
Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE
Part XV - Services for Special Populations
Subpart 7 - Targeted Case Management
Chapter 113 - Early and Periodic Screening, Diagnosis and Treatment
Section XV-11303 - Recipient Qualifications
Universal Citation: LA Admin Code XV-11303
Current through Register Vol. 50, No. 9, September 20, 2024
A. In order to be eligible to receive case management services, the EPSDT recipient shall be between the age of 0 and 21 and meet one of the following criteria:
1. placement on the Request for Services
Registry and determined to be eligible for OCDD services through the statement
of approval process; or
2. for
those who do not meet eligibility, or who are not undergoing eligibility
determination, may still receive case management services if they meet the
definition of a person with special needs.
a.
Special Needs-a documented, established medical condition, as
determined by a licensed physician or other qualified licensed health care
practitioner in accordance with
§10501.C 10, that has a
high probability of resulting in a developmental delay or that gives rise to a
need for multiple medical, social, educational, and other services. In the case
of a hearing impairment, the determination of special needs must be made by a
licensed audiologist or physician or other qualified licensed health care
practitioner in accordance with
§10501.C 10.
3. Documentation that
substantiates that the EPSDT recipient meets the definition of special needs
for case management services includes, but is not limited to:
a. receipt of special education services
through the state or local education agency; or
b. receipt of regular services from one or
more physicians or other qualified licensed health care practitioner in
accordance with
§10501.C 10;
or
c. receipt of or application for
financial assistance such as SSI because of a medical condition, or the
unemployment of the parent due to the need to provide specialized care for the
child; or
d. a report by the
recipient's physician or other qualified licensed health care practitioner in
accordance with
§10501.C 10 of multiple
health or family issues that impact the recipient's ongoing care; or
e. a determination of developmental delay
based upon:
i. the Parents' Evaluation of
Pediatric Status;
ii. the Brigance
Screens;
iii. the Child Development
Inventories;
iv. an appropriate
screening tool; or
v. any other
nationally-recognized diagnostic tool.
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.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.
