Current through Register Vol. 50, No. 9, September 20, 2024
A. Professional
services are services designed to increase the beneficiary's independence,
participation and productivity in the home, work and community. Beneficiaries,
up to the age of 21, who participate in NOW must access these services through
the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program.
Professional services may only be furnished and reimbursed through NOW when the
services are not covered under the Medicaid State Plan. Professional services
must be delivered with the beneficiary present and be provided based on the
approved CPOC and an individualized service plan. Service intensity, frequency
and duration will be determined by individual need. Professional services may
be utilized to:
1. perform assessments and/or
re-assessments and recommendations;
2. provide consultative services and
recommendations;
3. provide
training or therapy to a beneficiary and/or his/her natural and formal supports
necessary to either develop critical skills that may be self-managed by the
beneficiary or maintained according to the beneficiary's needs;
4. intervene in and stabilize a crisis
situation, behavioral or medical, that could result in the loss of home and
community-based services; or
5.
provide necessary information to the beneficiary, family, caregivers and/or
team to assist in the implementation of plans according to the approved
CPOC.
B. Professional
services are limited to the following services.
1. Psychological services are direct services
performed by a licensed psychologist, as specified by state law and licensure.
These services are for the treatment of a behavioral or mental condition that
addresses personal outcomes and goals desired by the beneficiary and his/her
team. Services must be reasonable and necessary to preserve and improve or
maintain adaptive behaviors or decrease maladaptive behaviors of a person with
developmental disabilities. Service intensity, frequency, and duration will be
determined by individual need.
2.
Social work services are highly specialized direct counseling services
furnished by a licensed clinical social worker and designed to meet the unique
counseling needs of individuals with development disabilities. Counseling may
address areas such as human sexuality, depression, anxiety disorders, and
social skills. Services must only address those personnel outcomes and goals
listed in the approved CPOC.
3.
Nutritional/Dietary services are medically necessary direct services provided
by a licensed registered dietician or licensed nutritionist. Services must be
ordered by a physician. Direct services may address health care and nutritional
needs related to prevention and primary care activities, treatment and diet.
Reimbursement is only available for the direct service performed by a dietitian
or nutritionist, and not for the supervision of a dietician or nutritionist
performing the hands-on direct service.
C. Service Limits. There shall be a $2,250
cap per beneficiary per CPOC year for the combined range of professional
services in the same day but not at the same time. Additional services may be
prior authorized if the beneficiary reaches the cap before the expiration of
the comprehensive plan of care and the beneficiary's health and safety are at
risk. One or more professional services may be utilized in the same day, but
not at the same time.
D. Provider
Qualifications. The provider of professional services must be a
Medicaid-enrolled provider. Each professional must possess a current valid
Louisiana license to practice in his/her field and have at least one year of
experience post licensure in his/her area of expertise.
E. Non-reimbursable Activities. The following
activities are not reimbursable:
1. friendly
visiting, attending meetings;
2.
time spent on paperwork or travel;
3. time spent writing reports and progress
notes;
4. time spent on the billing
of services; and
5. other
non-Medicaid reimbursable activities.
AUTHORITY
NOTE: Promulgated in accordance with
R.S.
36:254 and Title XIX of the Social Security
Act.
