Louisiana Department of Health COVID-19 temporary measures

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.

Measures changing

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.

Measures continuing

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:

• Electronic health records (EHR)
• Audio/video platforms
• Telephone

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:

• The E&M visit was/is related to the original issue, and
• The E&M visit is with the same specialist (or group) and was completed in addition to the e-consult

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.

• CPT^® 99451: E-consult services provided by a consultative physician, including a written report to the patient’s treating/requesting physician or other qualified healthcare professional; 5 minutes or more of medical consultative time.

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.

• Reimbursement is the same as in-person services
• CMS1500 billers must use Place of Service (POS) 02 and append modifier -95 on all claim lines
• UB04 billers must bill telehealth claims using the normal revenue code and applicable procedure code with modifier -95
• POS 02 does not apply to the UB04 form
• Services delivered using an audio/video system and those using an audio-only system should be coded this same way

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. 

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