Louisiana Administrative Code
Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE
Part XXXIII - Behavioral Health Services
Subpart 1 - Healthy Louisiana and Coordinated System of Care Waiver
Chapter 3 - Managed Care Organizations and the Coordinated System of Care Contractor Participation
Section XXXIII-301 - Participation Requirements and Responsibilities
Universal Citation: LA Admin Code XXXIII-301
Current through Register Vol. 50, No. 9, September 20, 2024
A. In order to participate in the Medicaid Program, an MCO and the CSoC contractor shall execute a contract with the department, and shall comply with all of the terms and conditions set forth in the contract.
B. MCOs and the CSoC contractor shall:
1. manage contracted
services;
2. establish
credentialing and re-credentialing policies consistent with federal and state
regulations;
3. ensure that
provider selection policies and procedures do not discriminate against
particular providers that serve high-risk populations or specialize in
conditions that require costly treatment;
a.
Repealed.
4. maintain a
written contract with subcontractors that specifies the activities and
reporting responsibilities delegated to the subcontractor, and such contract
shall also provide for the MCOs or CSOC contractors right to revoke said
delegation, terminate the contract, or impose other sanctions if the
subcontractors performance is inadequate;
5. contract only with providers of services
who are licensed and/or certified according to state laws, regulations, rules,
the provider manual and other notices or directives issued by the department,
meet the state of Louisiana credentialing criteria and enrolled with the Bureau
of Health Services Financing, or its designated contractor, after this
requirement is implemented;
6.
ensure that contracted rehabilitation providers are employed by a
rehabilitation agency or clinic licensed and authorized under state law to
provide these services;
7.
sub-contract with a sufficient number of providers to render necessary services
to Medicaid recipients/enrollees;
8. require each provider to implement
mechanisms to assess each Medicaid enrollee identified as having special health
care needs in order to identify special conditions of the enrollee that require
a course of treatment or regular care monitoring;
9. ensure that treatment plans or plans of
care meet the following requirements:
a. are
developed by the enrollees primary care provider (PCP) or behavioral health
provider with the enrollees participation and in consultation with any
specialists providing care to the enrollee, with the exception of treatment
plans or plans of care developed for recipients in the Home and Community Based
Services (HCBS) Waiver. The wraparound agency shall develop plans of care
according to wraparound best practice standards for recipients who receive
behavioral health services through the HCBS Waiver;
b. are approved by the MCO or CSoC contractor
in a timely manner, if required;
c.
are in accordance with any applicable state and federal quality assurance and
utilization review standards; and
d. allow for direct access to any specialist
for the enrollees condition and identified needs, in accordance with the
contract; and
10. ensure
that Medicaid recipients/enrollees receive information:
a. in accordance with federal regulations and
as described in the contract and departmental guidelines;
b. on available treatment options and
alternatives in a manner appropriate to the enrollees condition and ability to
understand; and
c. about available
experimental treatments and clinical trials along with information on how such
research can be accessed even though the Medicaid Program will not pay for the
experimental treatment.
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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