reglab/statecodes huggingface dataset:
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXXIII - Behavioral Health Services › Subpart 5 - School-Based Behavioral Health Services › Chapter 45 - Provider Participation › Section XXXIII-4501 - Local Education Agency Responsibilities

Current through Register Vol. 50, No. 6, June 20, 2024
A. The LEA shall ensure that its licensed and
				  unlicensed behavioral health practitioners are employed according to the
				  requirements specified under IDEA.
B. An LEA shall ensure that individual
				  practitioners are in compliance with Medicaid qualifications, Department of
				  Education Bulletin 746, and Louisiana Standards for State Certification of
				  School Personnel prior to billing the Medicaid Program for any school based
				  behavioral health services rendered by clinicians.
C. All services shall be delivered in
				  accordance with federal and state laws and regulations, the provisions of this
				  Rule, the provider manual, and other notices or directives issued by the
				  department.
D. Providers of
				  behavioral health services shall ensure that all services are authorized and
				  any services that exceed established limitations beyond the initial
				  authorization are approved for re-authorization prior to service delivery.
E. Anyone providing behavioral
				  health services must be operating within the scope of practice of their
				  applicable license. The provider shall create and maintain documents to
				  substantiate that all requirements are met.
F. Providers shall maintain case records that
				  include, at a minimum:
1. a copy of the
				  treatment plan;
2. a copy of the
				  IEP, IHP, etc.;
3. the name of the
				  child or youth receiving services;
4. the dates of service;
5. the nature, content and units of services
				  provided;
6. the progress made
				  toward functional improvement; and
7. the goals of the treatment plan.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXXIII - Behavioral Health Services › Subpart 5 - School-Based Behavioral Health Services › Chapter 47 - Payments › Section XXXIII-4701 - Reimbursement Methodology

Current through Register Vol. 50, No. 6, June 20, 2024
A. Payments
				  for school based behavioral health services shall be based on the most recent
				  school years actual cost as determined by desk review and/or audit for each LEA
				  provider.
1. Each LEA shall determine cost
				  annually by using LDHs cost report for behavioral health service cost form
				  based on the direct services cost report.
2. Direct cost shall be limited to the amount
				  of total compensation (salaries, vendor payments and fringe benefits) of
				  current behavioral health service providers as allocated to medical services
				  for Medicaid recipients. The direct cost related to the electronic health
				  record shall be added to the compensation costs to arrive at the total direct
				  costs for behavioral health services. There are no additional direct costs
				  included in the rate.
3. Indirect
				  cost shall be derived by multiplying the cognizant agency indirect cost
				  unrestricted rate assigned by the Department of Education to each LEA. There
				  are no additional indirect costs included.
4. To determine the amount of behavioral
				  health services cost that may be attributed to Medicaid; the ratio of total
				  Medicaid students in the LEA to all students in the LEA is multiplied by total
				  direct cost. Cost data is subject to certification by each LEA. This serves as
				  the basis for obtaining federal Medicaid funding.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXXIII - Behavioral Health Services › Subpart 5 - School-Based Behavioral Health Services › Chapter 47 - Payments › Section XXXIII-4703 - Cost Calculations (Repealed)

Current through Register Vol. 50, No. 6, June 20, 2024
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 36:254 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXXIII - Behavioral Health Services › Subpart 7 - Adult Mental Health Services › Chapter 61 - General Provisions › Section XXXIII-6101 - Introduction

Current through Register Vol. 50, No. 6, June 20, 2024
A. The Medicaid
				  Program provides coverage under the Medicaid State Plan for mental health
				  services rendered to adults with mental health disorders. These services shall
				  be administered under the authority of the Department of Health and Hospitals,
				  in collaboration with the managed care organizations (MCOs), which shall be
				  responsible for the necessary operational and administrative functions to
				  ensure adequate service coordination and delivery.
B. The mental health services rendered to
				  adults shall be necessary to reduce the disability resulting from mental
				  illness and to restore the individual to his/her best possible functioning
				  level in the community.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 36:254 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXXIII - Behavioral Health Services › Subpart 7 - Adult Mental Health Services › Chapter 61 - General Provisions › Section XXXIII-6103 - Recipient Qualifications

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Individuals, 21 years of age and older, who meet Medicaid eligibility, shall
				  qualify to receive adult mental health services referenced in LAC
				  50:XXXIII.6307 if medically necessary in accordance with LAC 50:1.1101, if the
				  recipient presents with mental health symptoms that are consistent with a
				  diagnosable mental disorder, and the services are therapeutically appropriate
				  and most beneficial to the recipient.
B. Additional Recipient Eligibility Criteria
				  for Community Psychiatric Support and Treatment (CPST) and Psychosocial
				  Rehabilitation (PSR)
1. Members must meet the
				  Substance Abuse and Mental Health Services Administration (SAMHSA) definition
				  of, serious mental illness (SMI). In addition to having a diagnosable mental
				  disorder, the condition must substantially interfere with, or limit, one or
				  more major life activities, such as:
a. basic
				  daily living (for example, eating or dressing);
b. instrumental living (for example, taking
				  prescribed medications or getting around the community); or
c. participating in a family, school, or
				  workplace.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXXIII - Behavioral Health Services › Subpart 7 - Adult Mental Health Services › Chapter 63 - Services › Section XXXIII-6301 - General Provisions

Current through Register Vol. 50, No. 6, June 20, 2024
A. All
				  mental health services must be medically necessary, in accordance with the
				  provisions of LAC 50:I.1101. The medical necessity for services shall be
				  determined by a licensed mental health practitioner or physician who is acting
				  within the scope of his/her professional license and applicable state law.
B. All services must be
				  authorized.
C. There shall be
				  recipient involvement throughout the planning and delivery of services.
1. Services shall be:
a. delivered in a culturally and
				  linguistically competent manner; and
b. respectful of the individual receiving
				  services.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXXIII - Behavioral Health Services › Subpart 7 - Adult Mental Health Services › Chapter 63 - Services › Section XXXIII-6303 - Assessments

Current through Register Vol. 50, No. 6, June 20, 2024
A. Assessments
				  shall be performed by a licensed mental health practitioner (LMHP).
B. Assessments for community psychiatric
				  support and treatment (CPST) and psychosocial rehabilitation (PSR) must be
				  performed at least once every 365 days or any time there is significant change
				  to the enrollee's circumstances.
C.
				  Repealed.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 36:254 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXXIII - Behavioral Health Services › Subpart 7 - Adult Mental Health Services › Chapter 63 - Services › Section XXXIII-6305 - Treatment Plan

Current through Register Vol. 50, No. 6, June 20, 2024
A. Each enrollee
				  who receives community psychiatric support and treatment (CPST) and
				  psychosocial rehabilitation (PSR) services shall have a treatment plan
				  developed based upon the assessment.
B. The individualized treatment plan shall be
				  developed according to the criteria established by the department and in
				  accordance with the provisions of this Rule, the provider manual and other
				  notices or directives issued by the department.
1. The treatment plan shall be reviewed at
				  least once every 180 days or when there is a significant change in the
				  individual's circumstances.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXXIII - Behavioral Health Services › Subpart 7 - Adult Mental Health Services › Chapter 63 - Services › Section XXXIII-6307 - Covered Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				  following mental health services shall be reimbursed under the Medicaid
				  Program:
1. ...
2. rehabilitation services, including
				  community psychiatric support and treatment (CPST), psychosocial rehabilitation
				  (PSR), and peer support services;
3. crisis intervention; and
4. crisis stabilization.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXXIII - Behavioral Health Services › Subpart 7 - Adult Mental Health Services › Chapter 65 - Provider Participation › Section XXXIII-6501 - Provider Responsibilities

Current through Register Vol. 50, No. 6, June 20, 2024
A. Each
				  provider of adult mental health services shall enter into a contract with one
				  or more of the managed care organizations (MCOs) in order to receive
				  reimbursement for Medicaid covered services.
B. Providers shall deliver all services in
				  accordance their license and scope of practice, with federal and state laws and
				  regulations, the provisions of this Rule, the provider manual and other notices
				  or directives issued by the department. The provider shall create and maintain
				  documents to substantiate that all requirements are met.
C. - D.9. Repealed.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 36:254 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXXIII - Behavioral Health Services › Subpart 7 - Adult Mental Health Services › Chapter 67 - Reimbursement › Section XXXIII-6701 - Reimbursement Methodology

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Effective for dates of service on or after December 1, 2015, the department, or
				  its fiscal intermediary, shall make monthly capitation payments to the managed
				  care organizations (MCOs).
B. The
				  capitation rates paid to the MCOs shall be actuarially sound rates and the MCOs
				  will determine the rates paid to its contracted providers. No payment shall be
				  less than the minimum Medicaid rate.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 36:254 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXXIII - Behavioral Health Services › Subpart 8 - Services for Targeted Populations › Chapter 71 - General Provisions › Section XXXIII-7101 - Introduction

Current through Register Vol. 50, No. 6, June 20, 2024
A. The Medicaid
				  program hereby adopts provisions to provide coverage under the 1915(b)(3)
				  waiver for services rendered to the targeted population of adults with mental
				  health disorders who have transitioned from a nursing facility or been diverted
				  from nursing facility level of care. These services shall be administered under
				  the authority of the Department of Health, in collaboration with the managed
				  care organizations (MCOs), which shall be responsible for the necessary
				  operational and administrative functions to ensure adequate service
				  coordination and delivery.
B.
				  Personal care services (PCS) rendered to adults shall be necessary to assist
				  and provide supervision with activities of daily living or to restore the
				  individual to his/her best possible functioning level in the
				  community.
C. Individual placement
				  and support (IPS) services rendered to adults shall be necessary to reduce the
				  disability resulting from mental illness and to restore the individual to
				  his/her best possible functioning level in the community.
AUTHORITY
					 NOTE: Promulgated in accordance with
					 R.S.
					 36:254 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXXIII - Behavioral Health Services › Subpart 8 - Services for Targeted Populations › Chapter 71 - General Provisions › Section XXXIII-7103 - Recipient Qualifications

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				  targeted population for the 1915(b)(3) services shall be Medicaid recipients
				  who:
1. are at least 21 years of
				  age;
2. have a qualifying mental
				  health diagnosis;
3. meet medical
				  necessity in accordance with LAC 50:I.1101; and
4. have transitioned from a nursing facility
				  or been diverted from nursing facility level of care.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXXIII - Behavioral Health Services › Subpart 8 - Services for Targeted Populations › Chapter 73 - Provider Participation › Section XXXIII-7301 - General Provisions

Current through Register Vol. 50, No. 6, June 20, 2024
A. All
				  services must be medically necessary, in accordance with the provisions of LAC
				  50:I.1101. The medical necessity for services shall be determined by a licensed
				  mental health practitioner or physician who is acting within the scope of
				  his/her professional license and applicable state law.
B. All services must be prior authorized.
				  Services which exceed the initial authorization must be approved for
				  reauthorization prior to service delivery.
C. There shall be recipient involvement
				  throughout the planning and delivery of services.
1. Services shall be:
a. delivered in a culturally and
				  linguistically competent manner; and
b. respectful of the individual receiving
				  services.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXXIII - Behavioral Health Services › Subpart 8 - Services for Targeted Populations › Chapter 73 - Provider Participation › Section XXXIII-7303 - Covered Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				  following services for the targeted populations shall be reimbursed under the
				  Medicaid Program:
1. personal care services
				  (PCS); and
2. individual placement
				  and support (IPS) services.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXXIII - Behavioral Health Services › Subpart 8 - Services for Targeted Populations › Chapter 75 - Provider Participation › Section XXXIII-7501 - Provider Responsibilities

Current through Register Vol. 50, No. 6, June 20, 2024
A. Each
				  provider of services for the target populations shall enter into a contract
				  with one or more of the managed care organizations (MCOs) in order to receive
				  reimbursement for Medicaid covered services.
B. Providers shall deliver all services in
				  accordance with their license and scope of practice, federal and state laws and
				  regulations, the provisions of this Rule, and other directives issued by the
				  department. The provider shall create and maintain documents to substantiate
				  that all requirements are met.
AUTHORITY
					 NOTE: Promulgated in accordance with
					 R.S.
					 36:254 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXXIII - Behavioral Health Services › Subpart 8 - Services for Targeted Populations › Chapter 77 - Reimbursement › Section XXXIII-7701 - Reimbursement Methodology

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				  department, or its fiscal intermediary, shall make monthly capitation payments
				  to the MCOs. The capitation rates paid to the MCOs shall be actuarially sound
				  rates and the MCOs will determine the rates paid to its contracted providers.
				  No payment shall be less than the minimum Medicaid rate.
AUTHORITY
					 NOTE: Promulgated in accordance with
					 R.S.
					 36:254 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXXIII - Behavioral Health Services › Subpart 9 - Home and Community-Based Services Waiver › Chapter 81 - General Provision › Section XXXIII-8101 - Introduction

Current through Register Vol. 50, No. 6, June 20, 2024
A. The Medicaid
				  Program hereby adopts provisions to provide coverage for behavioral health
				  services rendered to children with mental illness and severe emotional
				  disturbances (SED) by establishing a 1915(b)/(c) home and community-based
				  services (HCBS) waiver, known as the Coordinated System of Care (CSoC) waiver.
				  This HCBS waiver shall be administered under the authority of the Department of
				  Health, in collaboration with the coordinated system of care (CSoC) contractor,
				  which shall be responsible for the necessary operational and administrative
				  functions to ensure adequate service coordination and delivery.
B. The behavioral health services provided to
				  children in the HCBS waiver are those services necessary to reduce the
				  disability resulting from the illness and to restore the individual to his/her
				  best possible functioning level in the community.
C. The HCBS waiver is designed as a nursing
				  facility and hospitalization diversion program. The goal of this waiver is to
				  divert nursing facility and psychiatric hospitalization placement through the
				  provision of intensive home and community-based supportive services.
D. Local wraparound agencies will be the
				  locus of treatment planning for the provision of all services. Wraparound
				  agencies are the care management agencies for the day-to-day operations of the
				  waiver in the parishes they serve. The wraparound agencies shall enter into a
				  contract with the CSoC contractor and are responsible for the treatment
				  planning for the HCBS waiver in their areas, in accordance with
				  42 CFR
				  438.208(c).
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 36:254 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXXIII - Behavioral Health Services › Subpart 9 - Home and Community-Based Services Waiver › Chapter 81 - General Provision › Section XXXIII-8103 - Recipient Qualifications

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				  target population for the Home and Community-Based Behavioral Health Services
				  Waiver program shall be Medicaid recipients who:
1. are from the age of 5 years old through
				  the age of 20 years old effective March 1, 2017:
a. recipients enrolled in the program prior
				  to this date, who are between the ages of 0 through 4 or 20 through 21, may
				  continue to be served through this waiver as long as they continue to meet the
				  level of care criteria; and
b.
				  prospectively enrolled recipients must be at least age 5 through age 20 to
				  receive waiver services;
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXXIII - Behavioral Health Services › Subpart 9 - Home and Community-Based Services Waiver › Chapter 83 - Services › Section XXXIII-8301 - General Provisions

Current through Register Vol. 50, No. 6, June 20, 2024
A. All
				  behavioral health services must be medically necessary. The medical necessity
				  for services shall be determined by a licensed mental health practitioner
				  (LMHP) or physician who is acting within the scope of his/her professional
				  license and applicable state law.
B. All services shall be prior authorized.
				  Services which exceed the initial authorization must be approved for
				  re-authorization prior to service delivery.
C. Services provided to children and youth
				  must include communication and coordination with the family and/or legal
				  guardian and custodial agency for children in state custody. Coordination with
				  other child-serving systems should occur as needed to achieve the treatment
				  goals. All coordination must be documented in the child's medical record.
1.  The agency or individual who has the
				  decision making authority for a child or adolescent in state custody must
				  approve the provision of services to the recipient.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXXIII - Behavioral Health Services › Subpart 9 - Home and Community-Based Services Waiver › Chapter 83 - Services › Section XXXIII-8303 - Service Plan Development

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				  wraparound facilitator is responsible for convening the child and family team
				  to develop the initial waiver specific plan of care within 30 days of receipt
				  of referral from the managed care organization.
B. If new to the system, the recipient will
				  be receiving services based upon the preliminary plan of care (POC) while the
				  wraparound process is being completed.
C. The POC is reviewed every 90 days with the
				  recipient and parents or caregivers of the recipient. The wraparound
				  facilitator works directly with the recipient, the family (or the recipient's
				  authorized health care decision maker) and others to develop the POC. A crisis
				  plan must be included in each recipient's POC.
D. The wraparound agency will facilitate
				  development and implementation of a transition plan for each recipient
				  beginning at the age of 15 years old, as he/she approaches adulthood.
E. Entities and/or individuals that have
				  responsibility for service plan development may not provide other direct waiver
				  services to the participant.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 36:254 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXXIII - Behavioral Health Services › Subpart 9 - Home and Community-Based Services Waiver › Chapter 83 - Services › Section XXXIII-8305 - Covered Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				  following behavioral health services shall be provided in the HCBS waiver
				  program:
1. short-term respite
				  care;
2. independent living/skills
				  building;
3. youth support and
				  training; and
4. parent support and
				  training.
5.- 7.
				  Repealed.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXXIII - Behavioral Health Services › Subpart 9 - Home and Community-Based Services Waiver › Chapter 85 - Provider Participation › Section XXXIII-8501 - Provider Responsibilities

Current through Register Vol. 50, No. 6, June 20, 2024
A. Each
				  provider of home and community-based behavioral health waiver services shall
				  enter into a contract with the CSoC contractor in order to receive
				  reimbursement for Medicaid covered services.
B. All services shall be delivered in
				  accordance with federal and state laws and regulations, the provisions of this
				  Rule, the provider manual, and other notices or directives issued by the
				  department.
C. Providers of waiver
				  services shall ensure that all services are authorized and any services that
				  exceed established limitations beyond the initial authorization are approved
				  for re-authorization prior to service delivery.
D. Anyone providing behavioral health
				  services must be licensed in accordance with state laws and regulations, in
				  addition to operating within their scope of practice license. Providers
				  requiring certification in accordance with federal or state laws, regulations,
				  rules, the provider manual, or other notices or directives issued by the
				  department must be appropriately certified. To be certified or recertified,
				  providers shall meet the provisions of this Rule, the provider manual and the
				  appropriate statutes. The provider shall create and maintain documents to
				  substantiate that all requirements are met.
E. Providers shall maintain case records that
				  include, at a minimum:
1. a copy of the plan
				  of care;
2. the name of the
				  individual;
3. the dates of
				  service;
4. the nature, content and
				  units of services provided;
5. the
				  progress made toward functional improvement; and
6. the goals of the plan of care.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXXIII - Behavioral Health Services › Subpart 9 - Home and Community-Based Services Waiver › Chapter 87 - Reimbursement › Section XXXIII-8701 - Reimbursement Methodology

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				  department or its fiscal intermediary shall make monthly capitation payments to
				  the CSoC contractor.
1. The capitation rates
				  paid to the CSoC contractor shall be actuarially sound rates.
2. The CSoC contractor will make payments to
				  its contracted providers.
a. No payment shall
				  be less than the minimum Medicaid rate.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXXIII - Behavioral Health Services › Subpart 11 - Psychiatric Residential Treatment Facility Services › Chapter 101 - General Provisions › Section XXXIII-10101 - Introduction

Current through Register Vol. 50, No. 6, June 20, 2024
A. The Medicaid
				  Program hereby adopts provisions to provide coverage under the Medicaid State
				  Plan for behavioral health services rendered to children and youth in an
				  inpatient psychiatric residential treatment facility (PRTF). These services
				  shall be administered under the authority of the Department of Health and
				  Hospitals, in collaboration with managed care organizations and the coordinated
				  system of care (CSoC) contractor, which shall be responsible for the necessary
				  operational and administrative functions to ensure adequate service
				  coordination and delivery.
B. The
				  behavioral health services rendered to children with emotional or behavioral
				  disorders are those services necessary to reduce the disability resulting from
				  the illness and to restore the individual to his/her best possible functioning
				  level in the community.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 36:254 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXXIII - Behavioral Health Services › Subpart 11 - Psychiatric Residential Treatment Facility Services › Chapter 101 - General Provisions › Section XXXIII-10103 - Recipient Qualifications

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Individuals under the age of 21 with an identified mental health or substance
				  use diagnosis, who meet Medicaid eligibility and clinical criteria, shall
				  qualify to receive inpatient psychiatric residential treatment facility
				  services.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 36:254 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXXIII - Behavioral Health Services › Subpart 11 - Psychiatric Residential Treatment Facility Services › Chapter 103 - Services › Section XXXIII-10301 - General Provisions

Current through Register Vol. 50, No. 6, June 20, 2024
A. All
				  behavioral health services must be medically necessary. The medical necessity
				  for services shall be determined by a licensed mental health practitioner
				  (LMHP) or physician who is acting within the scope of his/her professional
				  license and applicable state law.
B. All services shall be prior authorized.
				  Services which exceed the initial authorization must be approved for
				  re-authorization prior to service delivery.
C. Services provided to children and youth
				  must include communication and coordination with the family and/or legal
				  guardian and custodial agency for children in state custody. Coordination with
				  other child-serving systems should occur as needed to achieve the treatment
				  goals. All coordination must be documented in the child's medical record.
1. The agency or individual who has the
				  decision making authority for a child or adolescent in state custody must
				  request and approve the provision of services to the recipient.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXXIII - Behavioral Health Services › Subpart 11 - Psychiatric Residential Treatment Facility Services › Chapter 103 - Services › Section XXXIII-10303 - Covered Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. The Medicaid
				  Program may reimburse a psychiatric residential treatment facility for the
				  following services:
1. physician (psychiatric)
				  services;
2. pharmacy
				  services;
3. diagnostic and
				  radiology services;
4. laboratory
				  services;
5. dental
				  services;
6. vision
				  services;
7. occupational
				  therapy;
8. physical
				  therapy;
9. speech-language
				  therapy; and
10. transportation
				  services.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXXIII - Behavioral Health Services › Subpart 11 - Psychiatric Residential Treatment Facility Services › Chapter 105 - Provider Participation › Section XXXIII-10501 - Provider Responsibilities

Current through Register Vol. 50, No. 6, June 20, 2024
A. Each
				  provider of PRTF services shall enter into a contract with one or more of the
				  MCOs and the CSoC contractor in order to receive reimbursement for Medicaid
				  covered services.
B. All services
				  shall be delivered in accordance with federal and state laws and regulations,
				  licensing regulations, the provisions of this Rule, the provider manual, and
				  other notices or directives issued by the department.
C. Providers of PRTF services shall ensure
				  that all services are authorized and any services that exceed established
				  limitations beyond the initial authorization are approved for re-authorization
				  prior to service delivery.
D.
				  Anyone providing PRTF services must be certified by the department, or its
				  designee, in addition to operating within their scope of practice license. To
				  be certified or recertified, providers shall meet the provisions of this Rule,
				  the provider manual and the appropriate statutes. The provider shall create and
				  maintain documents to substantiate that all requirements are met.
E. PRTF facilities shall be accredited by an
				  approved accrediting body and maintain such accreditation. Denial, loss of or
				  any negative change in accreditation status must be reported to its contracted
				  MCOs and the CSoC contractor in writing within the time limit established by
				  the department.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 36:254 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXXIII - Behavioral Health Services › Subpart 11 - Psychiatric Residential Treatment Facility Services › Chapter 107 - Reimbursement › Section XXXIII-10701 - General Provisions

Current through Register Vol. 50, No. 6, June 20, 2024
A. For
				  recipients enrolled with the CSoC contractor, reimbursement for services shall
				  be based upon the established Medicaid fee schedule for behavioral health
				  services. For recipients enrolled in one of the MCOs, the department or its
				  fiscal intermediary shall make monthly capitation payments to the MCOs. The
				  capitation rates paid to the MCOs shall be actuarially sound rates and the MCOs
				  will determine the rates paid to its contracted providers. No payment shall be
				  less than the minimum Medicaid rate. Covered inpatient, physician-directed PRTF
				  services rendered to children and youth shall be reimbursed according to the
				  following criteria:
1. Free-Standing PRTF
				  Facilities. The per diem rate shall include reimbursement for the following
				  services when included on the active treatment plan:
a. occupational therapy;
b. physical therapy;
c. speech therapy;
d. laboratory services; and
e. transportation services.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXXIII - Behavioral Health Services › Subpart 11 - Psychiatric Residential Treatment Facility Services › Chapter 107 - Reimbursement › Section XXXIII-10703 - In-State Publicly Owned and Operated Psychiatric Residential Treatment Facilities (Repealed)

Current through Register Vol. 50, No. 6, June 20, 2024
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 36:254 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXXIII - Behavioral Health Services › Subpart 11 - Psychiatric Residential Treatment Facility Services › Chapter 107 - Reimbursement › Section XXXIII-10705 - In-State Psychiatric Residential Treatment Facilities

Current through Register Vol. 50, No. 6, June 20, 2024
A. In-state publicly and privately owned and
				  operated PRTFs shall be reimbursed for covered PRTF services according to the
				  following provisions. The rate paid by the MCO or the CSoC contractor shall
				  take into consideration the following ownership and service criteria:
1. free-standing PRTFs specializing in
				  sexually-based treatment programs;
2. free-standing PRTFs specializing in
				  substance use treatment programs;
3. free-standing PRTFs specializing in
				  behavioral health treatment programs;
4. hospital-based PRTFs specializing in
				  sexually-based treatment programs;
5. hospital-based PRTFs specializing in
				  substance use treatment programs; and
6. hospital-based PRTFs specializing in
				  behavioral health treatment programs.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXXIII - Behavioral Health Services › Subpart 11 - Psychiatric Residential Treatment Facility Services › Chapter 107 - Reimbursement › Section XXXIII-10707 - Out-of-State Psychiatric Residential Treatment Facilities

Current through Register Vol. 50, No. 6, June 20, 2024
A. Out-of-state PRTFs shall be reimbursed in
				  accordance with the MCO or CSoC contractors established rate.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 36:254 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXXIII - Behavioral Health Services › Subpart 13 - Therapeutic Group Homes › Chapter 121 - General Provisions › Section XXXIII-12101 - Introduction

Current through Register Vol. 50, No. 6, June 20, 2024
A. The Medicaid
				  Program hereby adopts provisions to provide coverage under the Medicaid state
				  plan for behavioral health services rendered to children and youth in a
				  therapeutic group home (TGH). These services shall be administered under the
				  authority of the Department of Health (LDH), in collaboration with managed care
				  organizations (MCOs) and the coordinated system of care (CSoC) contractor for
				  children and youth enrolled in the CSoC program, which shall be responsible for
				  the necessary operational and administrative functions to ensure adequate
				  service coordination and delivery.
B. The specialized behavioral health services
				  rendered shall be those services medically necessary to reduce the disability
				  resulting from the illness and to restore the individual to his/her best
				  possible functioning level in the community.
C. A therapeutic group home provides a
				  community-based residential service in a home-like setting of no greater than
				  10 beds under the supervision and program oversight of a psychiatrist or
				  psychologist.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 36:254 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXXIII - Behavioral Health Services › Subpart 13 - Therapeutic Group Homes › Chapter 121 - General Provisions › Section XXXIII-12103 - Recipient Qualifications

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Individuals under the age of 21, who meet Medicaid eligibility and clinical
				  criteria, shall qualify to receive therapeutic group home services.
B.Qualifying children and adolescents with an
				  identified mental health or substance use diagnosis shall be eligible to
				  receive behavioral health services rendered by a TGH.
C. In order for a child to receive TGH
				  services:
1. the department, or its designee,
				  must have determined that less intensive levels of treatment are unsafe,
				  unsuccessful, or unavailable;
2.
				  the child must require active treatment that would not be able to be provided
				  at a less restrictive level of care on a 24-hour basis with direct
				  supervision/oversight by professional behavioral health staff; and
3. the child must attend a school in the
				  community.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXXIII - Behavioral Health Services › Subpart 13 - Therapeutic Group Homes › Chapter 123 - Services › Section XXXIII-12301 - General Provisions

Current through Register Vol. 50, No. 6, June 20, 2024
A. All
				  behavioral health services must be medically necessary. The medical necessity
				  for services shall be determined by a licensed mental health practitioner or
				  physician who is acting within the scope of his/her professional license and
				  applicable state law.
B. All
				  services shall be prior authorized. Services which exceed the initial
				  authorization must be approved for re-authorization prior to service
				  delivery.
C. Services provided to
				  children and youth must include communication and coordination with the family
				  and/or legal guardian and custodial agency for children in state custody.
				  Coordination with other child-serving systems should occur as needed to achieve
				  the treatment goals. All coordination must be documented in the child's medical
				  record.
1. The agency or individual who has
				  the decision making authority for a child or adolescent in state custody must
				  request and approve the provision of services to the recipient.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXXIII - Behavioral Health Services › Subpart 13 - Therapeutic Group Homes › Chapter 123 - Services › Section XXXIII-12303 - Covered Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. The Medicaid
				  Program may reimburse a therapeutic group home for the following services:
1. screening and assessment
				  services;
2. therapy services
				  (individual, group, and family whenever possible);
3. on-going psychiatric assessment and
				  intervention as needed; and
4.
				  skill-building services.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXXIII - Behavioral Health Services › Subpart 13 - Therapeutic Group Homes › Chapter 125 - Provider Participation › Section XXXIII-12501 - Provider Responsibilities

Current through Register Vol. 50, No. 6, June 20, 2024
A. Each
				  provider of TGH services shall enter into a contract with one or more of the
				  MCOs in order to receive reimbursement for Medicaid covered services. Providers
				  shall meet the provisions of this Rule, the provider manual, and the
				  appropriate statutes.
B. All
				  services shall be delivered in accordance with federal and state laws and
				  regulations, the provisions of this Rule, the provider manual, and other
				  notices or directives issued by the department. The provider shall create and
				  maintain documents to substantiate that all requirements are met.
C. Any services that exceed established
				  limitations beyond the initial authorization must be approved for
				  re-authorization prior to service delivery.
D. Anyone providing TGH services shall be
				  licensed in accordance with state laws and regulations, in addition to
				  operating within their scope of practice license.
E. TGH facilities shall be accredited by an
				  approved accrediting body and maintain such accreditation. Denial, loss of or
				  any negative change in accreditation status must be reported to their
				  contracted MCOs in writing within the time limit established by the department.
F. Providers of TGH services shall
				  be required to perform screening and assessment services upon admission and
				  within the timeframe established by the department thereafter to track progress
				  and revise the treatment plan to address any lack of progress and to monitor
				  for current medical problems and concomitant substance use issues.
G. A TGH must ensure that youth are receiving
				  appropriate therapeutic care to address assessed needs on the childs treatment
				  plan.
1. Therapeutic care may include
				  treatment by TGH staff, as well as community providers.
2. Treatment provided in the TGH or in the
				  community should incorporate research-based approaches appropriate to the
				  childs needs, whenever possible.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXXIII - Behavioral Health Services › Subpart 13 - Therapeutic Group Homes › Chapter 127 - Reimbursement › Section XXXIII-12701 - General Provisions

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				  department or its fiscal intermediary shall make monthly capitation payments to
				  the MCOs. The capitation rates paid to the MCOs shall be actuarially sound
				  rates and the MCOs will determine the rates paid to its contracted providers.
				  No payment shall be less than the minimum Medicaid rate.
1. Reimbursement for covered TGH services
				  shall be inclusive of, but not limited to:
a.
				  allowable cost of clinical and related services;
b. psychiatric support services;
c. allowable cost of integration with
				  community resources; and
d.
				  skill-building services provided by unlicensed practitioners.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXXIII - Behavioral Health Services › Subpart 13 - Therapeutic Group Homes › Chapter 127 - Reimbursement › Section XXXIII-12705 - In-State Therapeutic Group Homes

Current through Register Vol. 50, No. 6, June 20, 2024
A. In-state publicly and privately owned and
				  operated therapeutic group homes shall be reimbursed according to the MCO
				  established rate within their contract.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 36:254 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXXIII - Behavioral Health Services › Subpart 13 - Therapeutic Group Homes › Chapter 127 - Reimbursement › Section XXXIII-12707 - Out-of-State Therapeutic Group Homes

Current through Register Vol. 50, No. 6, June 20, 2024
A. Out-of-state therapeutic group homes shall
				  be reimbursed for their services according to the rate established by the
				  MCO.
B. Payments to out-of-state
				  TGH facilities that provide covered services shall not be subject to TGH cost
				  reporting requirements.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 36:254 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXXIII - Behavioral Health Services › Subpart 15 - Substance Use Disorders Services › Chapter 141 - General Provisions › Section XXXIII-14101 - Introduction

Current through Register Vol. 50, No. 6, June 20, 2024
A. The Medicaid
				  Program hereby adopts provisions to provide coverage under the Medicaid State
				  Plan for substance use disorders (SUD) services rendered to children and
				  adults. These services shall be administered under the authority of the
				  Department of Health (LDH), in collaboration with managed care organizations
				  (MCOs) and the coordinated system of care (CSoC) contractor, which shall be
				  responsible for the necessary operational and administrative functions to
				  ensure adequate service coordination and delivery. The CSoC contractor shall
				  only manage specialized behavioral health services for children and youth
				  enrolled in the CSoC program.
B.
				  The SUD services rendered shall be those services which are medically necessary
				  to reduce the disability resulting from the illness and to restore the
				  individual to his/her best possible level of functioning in the
				  community.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 36:254 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXXIII - Behavioral Health Services › Subpart 15 - Substance Use Disorders Services › Chapter 141 - General Provisions › Section XXXIII-14103 - Recipient Qualifications

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Children and adults who meet Medicaid eligibility and clinical criteria shall
				  qualify to receive medically necessary SUD services.
B. Qualifying children and adults with an
				  identified SUD diagnosis shall be eligible to receive SUD services covered
				  under the Medicaid state plan.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 36:254 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXXIII - Behavioral Health Services › Subpart 15 - Substance Use Disorders Services › Chapter 143 - Services › Section XXXIII-14301 - General Provisions

Current through Register Vol. 50, No. 6, June 20, 2024
A. All SUD
				  services must be medically necessary. The medical necessity for services shall
				  be determined by a licensed mental health practitioner (LMHP) or physician who
				  is acting within the scope of his/her professional license and applicable state
				  law.
B. American Society of
				  Addiction Medicine (ASAM) levels of care require reviews on an ongoing basis,
				  as deemed necessary by the department to document compliance with national
				  standards.
C. Children who are in
				  need of SUD services should be served within the context of the family and not
				  as an isolated unit. Services provided to children and youth shall include
				  communication and coordination with the family and/or legal guardian and
				  custodial agency for children in state custody provided that written consent is
				  obtained from minor. Coordination with other child-serving systems should occur
				  as needed to achieve the treatment goals subject to the minors consent and
				  applicable privacy laws. All coordination and consent must be documented in the
				  childs medical record.
1. Services shall be:
a. delivered in a culturally and
				  linguistically competent manner; and
b. respectful of the individual receiving
				  services.