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

Current through Register Vol. 50, No. 6, June 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				  Repealed.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.