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-305 - Service Delivery
Current through Register Vol. 50, No. 9, September 20, 2024
A. The MCOs and CSoC contractor shall ensure that services rendered to enrollees are medically necessary, are authorized or coordinated, and are provided by professionals according to their scope of practice and licensing in the state of Louisiana.
B. Access to emergency services and family-oriented services shall be assured within the network.
C. MCOs shall offer a contract to all federally qualified health centers (FQHCs), rural health clinics (RHCs), and tribal clinics. Enrollees shall have a choice of available providers in the plans network to select from. The CSoC contractor shall be required to contract with at least one FQHC in each medical practice region of the state (according to the practice patterns within the state) if there is an FQHC which can provide substance use disorder services or specialty mental health services under state law and to the extent that the FQHC meets the required provider qualifications.
D. MCOs and the CSoC contractor shall ensure that the recipient is involved throughout the planning and delivery of services.
AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.
