Medicaid Managed Care Policies & Procedures | Louisiana Department of Health

Medicaid Managed Care Policies & Procedures | Louisiana Department of Health Medicaid For Medicaid Partners Available for Public Comment Medicaid Managed Care Policies & Procedures Medicaid Managed Care Policies & Procedures In accordance with La. R.S. 46:460.51, et seq. , prior to adopting, approving, amending, or implementing certain policies or procedures, LDH will publish the proposed policy or procedure for the purpose of soliciting public comments. For this purpose, a policy or procedure, as defined by the statute, shall mean a requirement governing the administration of managed care organizations specific to billing guidelines, medical management and utilization review guidelines, case management guidelines, claims processing guidelines and edits, grievance and appeals procedures and process, other guidelines or manuals containing pertinent information related to operations and pre-processing claims, and core benefits and services. The following table contains the LDH and managed care organization policies and procedures that are open for public comment. Item Number Policy/Procedure Date Posted Comment Period Closed Status Document Links 2026-LHCC-532 Appropriate UM Professionals 4/20/26 6/4/26 Pending Appropriate UM Professionals 2026-LHCC-1224 Fetal Surgery in Utero 4/20/26 6/4/26 Pending Fetal Surgery in Utero 2026-LHCC-1483 Inpatient Consultation 4/20/26 6/4/26 Pending Inpatient Consultation 2026-LHCC-1515 Temporary Limited Authorization Reviews 4/20/26 6/4/26 Pending Temporary Limited Authorization Reviews 2026-HUM-1646 Cochlear Implant Clinical Coverage Policy 4/20/26 6/4/26 Pending Cochlear Implant Clinical Coverage Policy 2026-HBL-2805 Care at Home, Clinic at Home 4/20/26 6/4/26 Pending Care at Home, Clinic at Home 2026-LHCC-2808 Brain and Neck Computed Tomography Angiography (CTA) 4/20/26 6/4/26 Pending Brain and Neck Computed Tomography Angiography (CTA) 2026-HBL-2809 Additional State Specific Regulatory or Contractual Requirements 4/20/26 6/4/26 Pending Additional State Specific Regulatory or Contractual Requirements 2026-LHCC-2241 Concert Genetics Oncology Cancer Screening 4/9/26 5/24/26 Pending Concert Genetics Oncology Cancer Screening 2026-LHCC-2242 Concert Genetics Prenatal and Preconception Carrier Screening 4/9/26 5/24/26 Pending Concert Genetics Prenatal and Preconception Carrier Screening 2026-LHCC-2243 Concert Genetics Non-invasive Prenatal Screening 4/9/26 5/24/26 Pending Concert Genetics Non-invasive Prenatal Screening 2026-LHCC-2244 Concert Genetics Prenatal Diagnosis Pregnancy Loss 4/9/26 5/24/26 Pending Concert Genetics Prenatal Diagnosis Pregnancy Loss 2026-LHCC-2245 Concert Genetics Multi-system Inherited Disorders 4/9/26 5/24/26 Pending Concert Genetics Multi-system Inherited Disorders 2026-LHCC-2268 Genetic and Molecular Testing 4/9/26 5/24/26 Pending Genetic and Molecular Testing 2026-LHCC-2269 Concert Genetics Hereditary Cancer Susceptibility 4/9/26 5/24/26 Pending Concert Genetics Hereditary Cancer Susceptibility 2026-LHCC-2302 Concert Genetics Oncology Algorithmic Testing 4/9/26 5/24/26 Pending Concert Genetics Oncology Algorithmic Testing 2026-LHCC-2303 Concert Genetics Oncology Molecular Analysis of Solid Tumors and Hematologic Malignancies 4/9/26 5/24/26 Pending Concert Genetics Oncology Molecular Analysis of Solid Tumors and Hematologic Malignancies 2026-LHCC-2304 Concert Genetic Pharmacogenetics 4/9/26 5/24/26 Pending Concert Genetic Pharmacogenetics 2026-ABH-2800 Therapy Authorization Guidelines 4/9/26 5/24/26 Pending Therapy Authorization Guidelines 2026-LHCC-2801 Follow-Up, Limited or Localized Computed Tomography (CT) 4/9/26 5/24/26 Pending Follow-Up, Limited or Localized Computed Tomography (CT) 2026-ACLA-874 CT (Virtual) Colonoscopy 4/9/26 5/24/26 Pending CT (Virtual) Colonoscopy 2026-ACLA-879 Brain (Head) MRS 4/9/26 5/24/26 Pending Brain (Head) MRS 2026-LHCC-1214 Total Parenteral Nutrition and Intradialytic Parental Nutrition 4/9/26 5/24/26 Pending Total Parenteral Nutrition and Intradialytic Parental Nutrition 2026-LHCC-1358 Pancreas Transplantation 4/9/26 5/24/26 Pending Pancreas Transplantation 2026-LHCC-1362 Nonmyeloablative allogeneric SCT 4/9/26 5/24/26 Pending Nonmyeloablative allogeneric SCT 2026-LHCC-1363 Tandem Transplant 4/9/26 5/24/26 Pending Tandem Transplant 2026-LHCC-1934 Experimental Technologies 4/9/26 5/24/26 Pending Experimental Technologies 2026-LHCC-1935 Gastric Electrical Stimulation 4/9/26 5/24/26 Pending Gastric Electrical Stimulation 2026-LHCC-2178 Allogeneic Hematopoietic Progenitor Cell Therapy 4/9/26 5/24/26 Pending Allogeneic Hematopoietic Progenitor Cell Therapy 2026-LHCC-2227 Concert Genetics Cardiac Disorders 4/9/26 5/24/26 Pending Concert Genetics Cardiac Disorders 2026-LHCC-2228 Concert Genetics Eye Disorders 4/9/26 5/24/26 Pending Concert Genetics Eye Disorders 2026-LHCC-2229 Concert Genetics Dermatologic Conditions 4/9/26 5/24/26 Pending Concert Genetics Dermatologic Conditions 2026-LHCC-2230 Concert Genetics Epilepsy Neurodegenerative and Neuromuscular Conditions 4/9/26 5/24/26 Pending Concert Genetics Epilepsy Neurodegenerative and Neuromuscular Conditions 2026-LHCC-2231 Concert Genetics Gastroenterologic Disorders non-cancerous 4/9/26 5/24/26 Pending Concert Genetics Gastroenterologic Disorders non-cancerous 2026-LHCC-2233 Concert Genetics Hearing Loss 4/9/26 5/24/26 Pending Concert Genetics Hearing Loss 2026-LHCC-2234 Concert Genetics Lung Disorders 4/9/26 5/24/26 Pending Concert Genetics Lung Disorders 2026-LHCC-2235 Concert Genetics Kidney Disorders 4/9/26 5/24/26 Pending Concert Genetics Kidney Disorders 2026-LHCC-2236 Concert Genetics Immune Autoimmune and Rheumatoid Disorders 4/9/26 5/24/26 Pending Concert Genetics Immune Autoimmune and Rheumatoid Disorders 2026-LHCC-2237 Concert Genetics Hematologic Conditions non-cancerous 4/9/26 5/24/26 Pending Concert Genetics Hematologic Conditions non-cancerous 2026-LHCC-2238 Concert Genetics Skeletal Dysplasia Rare Bone Disorders 4/9/26 5/24/26 Pending Concert Genetics Skeletal Dysplasia Rare Bone Disorders 2026-LHCC-2240 Concert Genetics Preimplantation Genetic Testing 4/9/26 5/24/26 Pending Concert Genetics Preimplantation Genetic Testing 2026-ACLA-836 Pelvis MRI 4/1/26 5/16/26 Pending Pelvis MRI 2026-ACLA-837 Pelvis MRA 4/1/26 5/16/26 Pending Pelvis MRA 2026-ACLA-838 Pelvis CTAngiography 4/1/26 5/16/26 Pending Pelvis CTAngiography 2026-ACLA-839 Pelvis CT 4/1/26 5/16/26 Pending Pelvis CT 2026-ACLA-840 Neck MRA/MRV 4/1/26 5/16/26 Pending Neck MRA/MRV 2026-ACLA-841 Neck CTA 4/1/26 5/16/26 Pending Neck CTA 2026-ACLA-842 MUGA (Multiple Gated Acquisition) Scan 4/1/26 5/16/26 Pending MUGA (Multiple Gated Acquisition) Scan 2026-ACLA-843 Neck CT 4/1/26 5/16/26 Pending Neck CT 2026-ACLA-846 Lumbar Spine CT 4/1/26 5/16/26 Pending Lumbar Spine CT 2026-ACLA-847 Lumbar Spine MRI 4/1/26 5/16/26 Pending Lumbar Spine MRI 2026-ACLA-848 Lower Extremity MRI (foot, ankle, knee, leg, or hip MRI) 4/1/26 5/16/26 Pending Lower Extremity MRI (foot, ankle, knee, leg, or hip MRI) 2026-ACLA-849 Lower Extremity MRA/MRV 4/1/26 5/16/26 Pending Lower Extremity MRA/MRV 2026-ACLA-853 Heart MRI 4/1/26 5/16/26 Pending Heart MRI 2026-ACLA-857 CT Heart, CT Heart Congenital (Not including coronary arteries) 4/1/26 5/16/26 Pending CT Heart, CT Heart Congenital (Not including coronary arteries) 2026-ACLA-858 Upper Extremity MRA/MRV 4/1/26 5/16/26 Pending Upper Extremity MRA/MRV 2026-ACLA-859 Upper Extremity MRI 4/1/26 5/16/26 Pending Upper Extremity MRI 2026-ACLA-862 Upper Extremity CT 4/1/26 5/16/26 Pending Upper Extremity CT 2026-ACLA-863 Thoracic Spine MRI 4/1/26 5/16/26 Pending Thoracic Spine MRI 2026-ACLA-864 Lower Extremity CTA/CTV 4/1/26 5/16/26 Pending Lower Extremity CTA/CTV 2026-ACLA-865 Upper Extremity CTA/CTV 4/1/26 5/16/26 Pending Upper Extremity CTA/CTV 2026-ACLA-866 Thoracic Spine CT 4/1/26 5/16/26 Pending Thoracic Spine CT 2026-ACLA-867 Temporomandibular Joint (TMJ) MRI 4/1/26 5/16/26 Pending Temporomandibular Joint (TMJ) MRI 2026-ACLA-868 Spinal Canal MRA 4/1/26 5/16/26 Pending Spinal Canal MRA 2026-ACLA-869 Sinus & Maxillofacial CT Limited or Localized Follow Up Sinus CT 4/1/26 5/16/26 Pending Sinus & Maxillofacial CT Limited or Localized Follow Up Sinus CT 2026-ACLA-870 Temporal Bone, Mastoid, Orbits, Sella, Internal Auditory Canal CT 4/1/26 5/16/26 Pending Temporal Bone, Mastoid, Orbits, Sella, Internal Auditory Canal CT 2026-ACLA-871 Sinus Face Orbit MRI 4/1/26 5/16/26 Pending Sinus Face Orbit MRI 2026-ACLA-1448 PET Scans 4/1/26 5/16/26 Pending PET Scans 2026-ACLA-2249 Tumor Imaging PET-Any Site (Unlisted PET) 4/1/26 5/16/26 Pending Tumor Imaging PET-Any Site (Unlisted PET) 2026-LDH-9 MCO Manual > Louisiana Department of Children and Family Services (DCFS) 3/25/26 5/9/26 Pending MCO Manual – DCFS 2026-LHCC-1213 Sacroiliac Joint Fusion Evolent 3/20/26 5/4/26 Pending Sacroiliac Joint Fusion Evolent 2026-HUM-1584 Therapeutic Group Home 3/20/26 5/4/26 Pending Therapeutic Group Home 2026-LHCC-423 EPSDT 3/20/26 5/4/26 Pending EPSDT 2026-ABH-1331 Supporting Members in Crisis 3/20/26 5/4/26 Pending Supporting Members in Crisis 2026-HUM-1540 Crisis Stabilization for Adults 3/20/26 5/4/26 Pending Crisis Stabilization for Adults 2026-ACLA-2769 Call Center Manual 3/20/26 5/4/26 Pending Call Center Manual 2026-HBL-2799 LA Provider Training 3/20/26 5/4/26 Pending LA Provider Training 2026-ACLA-844 Low Field MRI 3/13/26 4/27/26 Pending Low Field MRI 2026-ACLA-850 Lower Extremity CT 3/13/26 4/27/26 Pending Lower Extremity CT 2026-ACLA-851 Low Dose CT for Lung Cancer Screening 3/13/26 4/27/26 Pending Low Dose CT for Lung Cancer Screening 2026-ACLA-856 Functional Brain MRI 3/13/26 4/27/26 Pending Functional Brain MRI 2026-ACLA-861 Breast MRI 3/13/26 4/27/26 Pending Breast MRI 2026-ACLA-874 CT (Virtual) Colonoscopy 3/13/26 4/27/26 Pending CT (Virtual) Colonoscopy 2026-ACLA-875 Chest (Thorax) CT 3/13/26 4/27/26 Pending Chest (Thorax) CT 2026-ACLA-876 Chest CTA 3/13/26 4/27/26 Pending Chest CTA 2026-ACLA-877 Chest MRA 3/13/26 4/27/26 Pending Chest MRA 2026-ACLA-878 Chest (Thorax) MRI 3/13/26 4/27/26 Pending Chest (Thorax) MRI 2026-ACLA-879 Brain (Head) MRS 3/13/26 4/27/26 Pending Brain (Head) MRS 2026-ACLA-880 Cervical Spine MRI 3/13/26 4/27/26 Pending Cervical Spine MRI 2026-ACLA-881 Cervical Spine CT 3/13/26 4/27/26 Pending Cervical Spine CT 2026-ACLA-882 Brain (Head) MRI, Brain (Head) MRI with IAC (Internal Auditory Canal) 3/13/26 4/27/26 Pending Brain (Head) MRI, Brain (Head) MRI with IAC (Internal Auditory Canal) 2026-ACLA-883 Brain (Head) CT 3/13/26 4/27/26 Pending Brain (Head) CT 2026-ACLA-884 Brain (Head) MRA/MRV 3/13/26 4/27/26 Pending Brain (Head) MRA/MRV 2026-ACLA-885 Brain (Head) CTA 3/13/26 4/27/26 Pending Brain (Head) CTA 2026-ACLA-886 Bone Marrow MRI 3/13/26 4/27/26 Pending Bone Marrow MRI 2026-ACLA-887 Abdominal Arteries CTAngiography 3/13/26 4/27/26 Pending Abdominal Arteries CTAngiography 2026-ACLA-888 Abdomen/Pelvis CTA Combo 3/13/26 4/27/26 Pending Abdomen/Pelvis CTA Combo 2026-ACLA-889 Abdomen MRA (Angiography) 3/13/26 4/27/26 Pending Abdomen MRA (Angiography) 2026-ACLA-890 Abdomen/Pelvis CT Combo 3/13/26 4/27/26 Pending Abdomen/Pelvis CT Combo 2026-ACLA-891 Abdomen MRI, MRCP 3/13/26 4/27/26 Pending Abdomen MRI, MRCP 2026-ACLA-892 Abdomen CT 3/13/26 4/27/26 Pending Abdomen CT 2026-ACLA-893 Abdomen CTAngiography 3/13/26 4/27/26 Pending Abdomen CTAngiography 2026-LHCC-934 Behavioral Health Provider Quality Program 3/13/26 4/27/26 Pending Behavioral Health Provider Quality Program 2026-ACLA-1147 Brain PET Scan 3/13/26 4/27/26 Pending Brain PET Scan 2026-LHCC-1833 Assertive Community Treatment (ACT) 3/13/26 4/27/26 Pending Assertive Community Treatment (ACT) 2026-LDH-1 MCO Manual > Part 4: Services > Professional Services > Obstetrics; effective date: 5/30/2026 3/9/26 4/23/26 Pending MCO Manual - Doula Services 2026-LDH-2 MCO Manual > Part 4: Services > Pharmacy > Medication Therapy Management; effective date: 5/30/2026 3/9/26 4/23/26 Pending MCO Manual - Cell and Gene Therapy Model 2026-LDH-3 MCO Manual > Part 4: Services > Medical Transportation; effective date: 5/30/2026 3/9/26 4/23/26 Pending MCO Manual - Medical Transportation 2026-LDH-4 MCO Manual > Part 11: Enrollee Services > Grievances, Appeal and State Fair Hearing; effective date: 5/30/2026 3/9/26 4/23/26 Pending MCO Manual - Grievances, Appeal and State Fair Hearing 2026-LDH-5 MCO Manual > Part 15: Program Integrity; effective date: 5/30/2026 3/9/26 4/23/26 Pending MCO Manual - Program Integrity 2026-LDH-6 MCO Manual > Part 9: Provider Network > Credentialing and Re-Credentialing of Providers and Clinical Staff > Specialized Behavioral Health Providers; effective date: 5/30/2026 3/9/26 4/23/26 Pending MCO Manual - Specialized Behavioral Health Providers 2026-LDH-7 MCO Manual > Part 4: Services > Professional Services > In Lieu of Services; effective date: 5/30/2026 3/9/26 4/23/26 Pending MCO Manual - ILOS 2026-LDH-8 MCO Manual > Part 4: Services > Professional Services > Physician Adminstered Drugs; effective date: 5/30/2026 3/9/26 4/23/26 Pending MCO Manual - Physician Administered Drugs 2026-HBL-2756 Remote Patient Monitoring In Lieu of Service (ILOS) 3/9/26 4/23/26 Pending Remote Patient Monitoring In Lieu of Service (ILOS) 2026-ABH-1179 Prior Authorizations 3/9/26 4/23/26 Pending Prior Authorizations 2026-LHCC-2184 Organizational Assessment and Reassessment 3/9/26 4/23/26 Pending Organizational Assessment and Reassessment 2026-ABH-2254 Benefit Exception Amendment 3/9/26 4/23/26 Pending Benefit Exception Amendment 2026-HBL-2790 PA Req Chngs-UM AROW CAID 3/9/26 4/23/26 Pending PA Req Chngs-UM AROW CAID 2026-ACLA-2795 Pre-Adjudication of Provider Claims for Diagnosis Accuracy 3/9/26 4/23/26 Pending Pre-Adjudication of Provider Claims for Diagnosis Accuracy Related Information Previously posted for public comment Managed Care Policies & Procedures - Archive (2026) Managed Care Policies & Procedures - Archive (2025) Managed Care Policies & Procedures - Archive (2024) Managed Care Policies & Procedures - Archive (2023) Managed Care Policies & Procedures - Archive (2022) Managed Care Policies & Procedures - Archive (2021) Managed Care Policies & Procedures - Archive (2020) Managed Care Policies & Procedures - Archive (2019) MCO Managed Care Policies and Procedures Public Comments LDH Managed Care Policies and Procedures Public Comments Surgeon General Evelyn Griffin, MD Secretary Bruce D. Greenstein Cicero Government