The Louisiana Department of Health (LDH) collects and updates their temporary measures in place due to COVID-19 in Informational Bulletin 20-5. The following is a summary of some of those exceptions.
Utilization management resumes
Effective March 21, 2022, utilization management (UM) requirements for all medical hospitalizations resumed.
Prior authorization resumes
Effective March 21, 2022, prior authorization requirements for lower levels of care (skilled nursing facilities, inpatient rehab, long-term acute care, etc.) resumed.
Authorization for home health services at discharge suspended
Effective Jan. 3, 2022, we’re automatically approving the initial authorization for home health services at hospital discharge. The hospital or home health agency must inform us that a member will be receiving post-discharge home health services so we can suspend the authorization requirements and prevent claim denials.
Quality and value-based payment programs
Louisiana Medicaid determined that incentives and value-based payment targets have returned to pre-COVID-19 expectations and assessments will be based on the actual performance.
Hospital discharge assistance
For help with hospital discharge problems, please call us at 504-220-0696, available 7 days a week, 24 hours a day.
E-consults
For dates of service on or after March 15, 2021, Louisiana Medicaid will reimburse interprofessional assessment and management services that occur electronically through:
Qualifying assessment and management services occur when a member’s treating practitioner contacts a practitioner with a different specialty or subspecialty for an opinion or treatment advice in the diagnosis or management of the member’s presenting issue. These electronic consultations replace in-person evaluation and management (E&M) visits.
However, these services aren’t reimbursable if there was an E&M visit with the specialist 14 days prior to, or will be an E&M visit 14 days after, the e-consult occurs if:
E-consult codes shall not be billed for regular communication that is expected to occur between a physician and an APRN collaborating with, or a PA supervised by, the physician.
Pharmacy
Effective March 17, 2020, members are eligible to receive up to a 90-day supply, as appropriate, of medications that are not controlled substances.
Durable Medical Equipment
Since March 17, 2020, members have been eligible to receive up to a 90-day quantity of supplies related to incontinence, diabetes, tracheostomy care, wound care, home dialysis, parenteral and enteral nutrition, apnea/breathing monitors and other respiratory supplies, home oxygen, electric breast pumps, pulse oximeter probes and tape, and intravenous therapy.
Note: Multifunction Ventilator (E0467) became a covered service effective March 1, 2020. This benefit was added to allow flexibility in the types of ventilators that can be used to meet member needs.
Telehealth
When otherwise covered by Louisiana Medicaid, telemedicine/telehealth is allowed for all CPT codes located in Appendix P of the CPT manual.
Physical, occupational and speech therapy
Louisiana Medicaid will reimburse the use of telehealth, when appropriate, for rendering covered physical therapy, occupational therapy and speech therapy to members.
ABA
Effective for dates of service on or after March 17, 2020, Louisiana Medicaid will reimburse the use of telehealth, when appropriate, for rendering certain Applied Behavior Analysis (ABA) services. Telehealth services can be used for the care of new or established patients or to support the caregivers of new or established patients.
EPSDT
Effective for dates of service on or after March 5, 2020, Louisiana Medicaid allows the use of telemedicine/telehealth to perform clinically appropriate components of Early and Periodic Screening, Diagnostic and Treatment (EPSDT) preventive services for members older than 24 months.
Code normal EPSDT preventive services by age (99381- 99385, 99391-99395) with telehealth modifier (95), reduced services modifier (52), and POS 02 on all claim lines.
Secondary Claims
If a primary insurance claim for telehealth services was processed with a POS equal to the primary carrier’s billing requirements and modifier 95 is appended to all procedure code(s) for a covered service, CMS1500 billers can submit secondary claims with the same POS. POS 02 is not required for coordination of benefits claims.
Questions?
Call us at 866-675-1607, 7 a.m. – 7 p.m., Monday – Friday.