Medicaid State Plan | Louisiana Department of Health
Source: http://dhh.louisiana.gov/medicaid/medicaid-state-plan
Archived: 2026-04-23 17:11
Medicaid State Plan | Louisiana Department of Health
Medicaid
For Medicaid Partners
Medicaid State Plan
Medicaid State Plan
State Plan Amendments
LaCHIP State Plan and Amendments
A Medicaid State Plan is a set of rules that the state uses to provide Medicaid health insurance to people who need it. Each state has its own plan that follows federal guidelines, but can also make some choices about how the program works. The plan details who is eligible for Medicaid, what services are covered, and how the state will pay for those services.
Section 1 - Single State Agency Organization
Section 1.1 -
Designation and Authority
Attachment 1.1a -
Certification of Single State Agency
Section 1.2 - Organization for Administration
Attachment 1.2a -
State Agency Organization and Functions
Attachment 1.2b -
Organization and Function of Bureau of Health Services Financing
Attachment 1.2c -
Professional Medical and Supporting Staff
Attachment 1.2d -
Description of Staff Making Eligibility Decisions
Section 1.3 -
Statewide Operation
Section 1.4 -
State Medical Care Advisory Committee
Section 1.5 -
Pediatric Immunization Program
Section 1.6 -
Tribal Consultation of SPA Process
Section 2 - Coverage and Eligibility
Section 2.1 -
Application Determination of Eligibility and Furnishing Medicaid
Section 2.2 -
Coverage and Conditions of Eligibility
Attachment 2.2a -
Groups Covered and Agencies Responsible for Eligibility
Supplement 1 -
Reasonable Classifications of Individuals
Section 2.3 -
Residence
Section 2.4 -
Blindness
Section 2.5 -
Disability
Section 2.6 -
Financial Eligibility
Attachment 2.6A
Eligibility Conditions and Requirements
Supplement 1 -
Eligibility Income Levels
Supplement 2 -
Eligibility Resource Levels
Supplement 3 -
Reasonable Limits
Supplement 5 -
Methodologies for Treatment of Income and Resources that Differ from SSI
Supplement 5a -
Methodologies for Treatment of Resources for Individuals with Income up to a Percentage of FPL
Supplement 6 -
Standards for Optional State Supplementary Payments
Supplement 7 -
Categorically Needy who are Covered under Requirements more Restrictive than SSI
Supplement 8a -
More Liberal Methods of Treating Income under 1902(r)(2) of the Act
Supplement 8b -
More Liberal Methods of Treating Resources under 1902(r)(2) of the Act
Supplement 8c -
State Long-Term Care Insurance Partnership
Supplement 9 -
Transfer of Resources
Supplement 9a -
Transfer of Assets
Supplement 10 -
Consideration of Medicaid Qualifying Trusts - Undue Hardship
Supplement 12 -
Variations from the Basic Personal Needs Allowance
Supplement 13 -
Section 1924 Provisions
Supplement 14 -
Income and Resource Requirements for Tuberculosis Infected Individuals
Supplement 15 -
Treatment of Optional Groups of Qualified Aliens
Supplement 16 -
Eligibility under Section 1931 of the Act
Supplement 17 -
Disqualification for Long-Term Care Assistance for Individuals with Substantial Home Equity
Supplement 18 –
Federal Medical Assistance Percentage (FMAP)
Section 2.7 -
Medicaid Furnished Out of State
Section 2.8 -
Modified Adjusted Gross Income (MAGI)
Section 2 - MMDL and MACPro System Approvals
MACPro -
General Eligibility Requirements - Application
MACPro - Eligibility and Enrollment Processes
Continuous Eligibility for Children
Continuous Eligibility for Pregnant Women and Extended Postpartum Coverage
MACPro – Eligibility Groups – Mandatory Coverage
Former Foster Care Children
Qualified Medicare Beneficiaries
Qualified Disabled and Working Individuals
Specified Low Income Medicare Beneficiaries
Qualifying Individuals
MACPro – Eligibility Groups – Optional Coverage
Children under Age 19 with a Disability
Age and Disability-Related Poverty Level
Individuals Eligible for Cash Except for Institutionalization
Individuals in Institutions Eligible under a Special Income Level
Medically Needy Population Based on Age, Blindness or Disability
Medically Needy
Optional Eligibility Groups
PACE Participants
Ticket to Work Basic
MACPro - General Administration
Reporting - Child and Adult Core Sets
OneMAC and MMDL SPAs
A1 - A3 Medicaid Administration
CS20 – SCHIP Non-Financial Eligibility – Substitution of Coverage
CS21 - CHIP Non-Financial Eligibility - Non-Payment of Premiums
CS31 - Incarcerated CHIP Beneficiaries
S10 - MAGI-Based Income Methodologies
S14 - AFDC Income Standards
S21 - Presumptive Eligibility by Hospitals
S25 - Mandatory Coverage - Parents and Other Caretaker Relatives
S28 - Mandatory Coverage - Pregnant Women
S30 - Mandatory Coverage - Infants and Children Under Age 19
S32 - Mandatory Coverage - Adult Group
S50 - Options for Coverage - Individuals above 133 FPL
S51 - Options for Coverage - Optional Coverage of Parents and Other Caretaker Relatives
S52 - Options for Coverage - Reasonable Classification of individuals Under Age 21
S53 - Options for Coverage - Children with Non IV-E Adoption Assistance
S54 - Options for Coverage - Optional Targeted Low Income Children
S55 - Options for Coverage - Individuals with Tuberculosis
S57 - Options for Coverage - Independent Foster Care Adolescents
S59 - Options for Coverage - Individuals Eligible for Family Planning Services
S88 - Non-Financial Eligibility State Residency
S89 - Non-Financial Eligibility Citizenship and Non-citizen Eligibility
S94 - General Eligibility Requirements - Eligibility Process
Section 3 - Services: General Provisions
Section 3.1 -
Amount, Duration and Scope of Services
Attachment 3.1a -
Amount Duration and Scope of Services for Categorically Needy
Item 1 -
Inpatient Hospital Services
Item 2a -
Outpatient Hospital Services
Item 2b -
Rural Health Clinic Services
Item 2c -
FQHC Services
Item 3 -
Other Laboratory and X-Ray Services
Item 4a -
Skilled Nursing and Surgical Services for Individuals 21 or Older
Item 4b -
EPSDT Services
Item 4c -
Family Planning
Item 5 -
Physician Services
Item 5b -
Medical and Surgical Services Furnished by a Dentist
Item 6 -
Medical and Remedial Care Furnished by Other Licensed Practitioners
Item 7 -
Home Health Care Services
Item 9 -
Clinic Services
Item 12a -
Prescribed Drugs
Item 12b -
Dentures
Item 12c -
Prosthetic Devices
Item 13c -
Preventive Services
Item 13d -
Rehabilitative Services
Item 14a -
Services for Individuals 65 or older in Institutions for Mental Diseases
Item 15 -
Intermediate Care Facility Services
Item 16 -
Inpatient Psychiatric Facility Services for Under 21
Item 17 -
Nurse Midwife Services
Item 18 -
Hospice Care Services
Item 19 -
Targeted Case Management Services
Item 19b -
Special Tuberculosis-Related Services for Tuberculosis Infected Individuals
Item 20a -
Pregnancy Related and Postpartum Services
Item 20b -
Extended Services for Pregnant Women
Item 23 -
Nurse Practitioner Services
Item 24a -
Medical Transportation Services
Item 24d -
Skilled Nursing Facility Services for Individuals Under 21
Item 26 -
Personal Care Services
Supplement 1 -
Targeted Case Management
Supplement 2 -
Self-Directed Personal Assistance Services
Supplement 3 -
PACE
Supplement 4 -
Medication-Assisted Treatment
Attachment 3.1b -
Amount, Duration and Scope of services Provided to Medically Needy Groups
Attachment 3.1c -
Standards and Methods for Assuring High Quality Care
Attachment 3.1d -
Methods of Providing Transportation
Attachment 3.1e -
Standards for Coverage of Organ Transplants
Attachment 3.1f -
Managed Care
Attachment 3.1m -
Mandatory Coverage for Eligible Juveniles Who are Inmates
Section 3.2 -
Coordination of Medicaid with Medicare and Other Insurance
Attachment 3.2a -
Coordination of Medicare
Section 3.3 -
Medicaid for Individuals 65 or Over in Institutions for Mental Disease
Section 3.4 -
Special Requirements Applicable to Sterilization Procedures
Section 3.5 -
Families Receiving Extended Medicaid Benefits
Section 3.6 -
Additional Amounts for Nursing Facility Residents
Section 3 - MMDL System Approvals
Alternative Benefit Plan (ABP)
ABP1 - Alternative Benefit Plan Populations
ABP2a - Voluntary Benefit Package Selection Assurances - Eligibility Group Under 1902
ABP3 - Selection of Benchmark Benefit Package or Benchmark-Equivalent Benefit Package
ABP4 - Alternative Benefit Plan Cost-Sharing
ABP5 - Benefits Description
ABP7 - Benefits Assurances
ABP8 - Service Delivery Systems
ABP9 - Employer Sponsored Insurance and Payment of Premiums
ABP11 - Payment Methodology
Section 4 - General Program Administration
Section 4.1 -
Methods of Administration
Section 4.2 -
Hearings for Applicants and Recipients
Attachment 4.2a -
Fair Hearings
Section 4.3 -
Safeguarding Information on Applicants and Recipients
Section 4.4 -
Medicaid Quality Control
Section 4.5 -
Medicaid Agency Fraud Detection and Investigation Program
Section 4.6 -
Reports
Section 4.7 -
Maintenance of Records
Section 4.8 -
Availability of Agency Program Manuals
Section 4.9 -
Reporting Provider Payments to the IRS
Section 4.10 -
Free Choice of Providers
Section 4.11 -
Relations with Standard-Setting and Survey Agencies
Attachment 4.11a -
Standards for Institutions
Section 4.12 -
Consultation to Medical Facilities
Section 4.13 -
Required Provider Agreement
Section 4.14 -
Utilization Control
Attachment 4.14b -
Utilization Review Methods for Intermediate Care Facilities
Section 4.15 -
Inspections of Care in Skilled Nursing and Intermediate Care Facilities and Institutions for Mental Disease
Section 4.16 -
Relations with State Health and Vocational Rehab Agencies and Title V Grantees
Attachment 4.16a -
Interrelations with State Health and Vocational Rehab Agencies and Title V Grantees
Section 4.17 -
Liens and Adjustments or Recoveries
Attachment 4.17a -
Liens and Adjustments or Recoveries
Section 4.18 - Medicaid Premiums and Cost Sharing
Attachment 4.18
G1 –
Cost Sharing Requirements
G2a –
Cost Sharing Amounts – Categorically Needy Individuals
G2b –
Cost Sharing Amounts – Medically Needy Individuals
G2c –
Cost Sharing Amounts – Targeting
G3 –
Cost Sharing Limitations
Section 4.19 -
Payment for Services
Attachment 4.19a
Item 1 -
Inpatient Hospital Services Reimbursement
Item 14a -
Services for Individuals 65 or Older in Institutions for Mental Diseases
Item 16 -
Inpatient Psychiatric Hospital Services for Individuals Under Age 21
Attachment 4.19b
Item 2a -
Outpatient Hospital Services
Item 2b -
Rural Health Clinic Services
Item 2c -
FQHC Services
Item 2d -
Reimbursement for Indian Health Services Tribal 638 Facilities
Item 3 -
Other Laboratory and X-Ray Services
Item 4b -
EPSDT Services
Item 4c -
Family Planning Services and Supplies for Individuals of Child Bearing Age
Item 5 -
Physician Services
Item 5b -
Medical and Surgical Services Provided by a Dentist
Item 6 -
Medical and Remedial Care Furnished by Other Licensed Providers
Item 7 -
Home Health Care Services
Item 9 -
Clinic Services
Item 12a -
Prescribed Drugs
Item 12b -
Dentures
Item 12c -
Prosthetic Devices
Item 13c -
Preventive Services
Item 13d -
Rehabilitative Services
Item 17 -
Nurse Midwife Services
Item 18 -
Hospice Care Services
Item 19 -
Targeted Case Management Services
Item 19b -
Special Tuberculosis-related Services for Tuberculosis Infected Individuals
Item 20a -
Pregnancy-related and Postpartum Services
Item 20b -
Extended Services for Pregnant Women
Item 23 -
Nurse Practitioner Services
Item 24a -
Medical Transportation Services
Item 24d -
Skilled Nursing Facility Services for Individuals under 21
Item 26 -
Personal Care Services
Item 28 -
Self-directed Personal Assistance Services
Item 28(i) -
Free-Standing Birthing Centers
Item 29 -
Medication-Assisted Treatment
Item 30 –
Qualifying Clinical Trials
Supplement 1 -
Payment Rates for Title XIII Part A and Part B Deductible/Coinsurance
Attachment 4.19c -
Methods of Payment for Reserving Beds During a Recipients Absence from an Inpatient Facility
Attachment 4.19d(1) -
Payments for Skilled Nursing Facilities
Attachment 4.19d(2) -
Payments for Intermediate Care Facilities
Attachment 4.19e -
Timely Claims Payment - Definition of Claim
Section 4.20 -
Direct Payment to Certain Recipients for Physician or Dentist Services
Section 4.21 -
Prohibition Against Reassignment of Provider Claims
Section 4.22 -
Third Party Liability
Attachment 4.22a -
Requirements for Third Party Liability - Identifying Liable Resources
Attachment 4.22b -
Requirements for Third Party Liability - Payment of Claims
Attachment 4.22c -
Requirements for Third Party Liability - Cost Effectiveness for Employer Based Group Health Benefit Plans
Supplement 1 -
State Laws Requiring Third Parties to Provide Coverage Eligibility and Claims Data
Section 4.23 -
Use of Contracts
Section 4.24 -
Standards for Payments for Skilled Nursing and Intermediate Care Facility Services
Section 4.25 -
Program for Licensing Administrators of Nursing Homes
Section 4.26 -
Drug Utilization Program
Section 4.27 -
Disclosure of Survey Information and Provider or Contractor Evaluation
Section 4.28 -
Appeals Process for Skilled Nursing and Intermediate Care Facility Services
Section 4.29 -
Conflict of Interest Provisions
Section 4.30 -
Exclusion of Providers and Suspension of Practitioners and Other Individuals
Attachment 4.30 -
Sanctions for Psychiatric Hospitals
Section 4.31 -
Disclosure of Information by Providers and Fiscal Agents
Section 4.32 -
Income and Eligibility Verification System
Attachment 4.32a -
Income and Eligibility Verification System Procedures - Requests to Other State Agencies
Section 4.33 -
Medicaid Eligibility Cards for Homeless Individuals
Attachment 4.33a -
Method for Issuance of Medicaid Eligibility Cards to Homeless Individuals
Section 4.34 -
Systematic Alien Verification for Entitlements
Attachment 4.34a -
Requirements for Advance Directives
Section 4.35 -
Enforcement of Compliance for Nursing Homes
Attachment 4.35a -
Enforcement of Compliance for Nursing Facilities
Section 4.36 -
Required Coordination Between Medicaid and WIC Programs
Section 4.38 -
Nurse Aide Training and Competency Evaluation for Nursing Facilities
Attachment 4.38 -
Collection and Disclosure of Additional Registry Information
Section 4.39 -
Pre-admission Screening and Annual Resident Review in Nursing Facilities
Attachment 4.39 -
Definition of Specialized Services
Attachment 4.39a -
Categorical Determinations
Section 4.41 -
Resident Assessment for Nursing Facilities
Section 4.42 -
Employee Education About False Claims Recoveries
Attachment 4.42a -
Method of Compliance Oversight and Frequency with which the State will Reassess Compliance
Section 4.43 -
Cooperation with Medicaid Integrity Program Efforts
Section 4.44 -
Prohibition on Payments to Institutions or Entities Located Outside the U.S.
Section 4.46 -
Provider Screening and Enrollment
Section 5 - Personnel Administration
Section 5.1 -
Standards of Personnel Administration
Section 5.2 -
Reserved
Section 5.3 -
Training Programs - Sub-professional and Volunteer Programs
Section 6 - Financial Administration
Section 6.1 -
Fiscal Policies and Accountability
Section 6.2 -
Cost Allocation
Section 6.3 -
State Financial Participation
Section 7 - General Provisions
Section 7.1 -
Plan Amendments
Section 7.2 -
Non-discrimination
Attachment 7.2a -
Methods of Administration - Compliance with Civil Rights Act (Title VI)
Section 7.4 -
State Governor's Review
Section 7.4.A -
Rescissions to Medicaid Disaster Relief COVID-19 National Emergency
Section 7.4.B - Temporary Extensions to the Disaster Relief Policies for the COVID-19 National Emergency
23-0015 LA Medicaid Disaster Relief SPA Signature Waiver (Pharmacy)
23-0019 Long Term-Personal Care Services Disaster Relief Extension
23-0023 Disaster Relief Extension SPA (Long Term-Personal Care Services)
23-0030 Medicaid Disaster Relief Extension (Treatment in Place)
Section 7.4.C - Temporary Policies in Effect Following the COVID-19 National Emergency
23-0017 Targeted Case Management
23-0018 Disaster Relief Extension (Long Term - Personal Care Services)
Section 7.4.1 -
Medicaid Disaster Relief COVID-19 National Emergency
Medicaid Disaster Relief Increase Reimbursement Vaccine Administration
Medicaid Disaster Relief Laboratory Services
Medicaid Disaster Relief Administrative Claiming
Medicaid Disaster Relief FQHC and RHC - Alternative Payment Methodology
Medicaid Disaster Relief FQHC and RHC - Alternative Payment Methodology COVID-19 Monoclonal Treatment
Medicaid Disaster Relief SPA - ICF-IID Direct Care Add-On
Medicaid Disaster Relief SPA – Home and Community-Based Services Spending Plan – Targeted Case Management and Personal Care Services
Medicaid Disaster Relief SPA – Home and Community-Based Services - Personal Care Services
Section 7.7 -
COVID-19 Vaccine and Vaccine Administration, Testing, and Treatment
Section 7.7-A -
COVID-19 Vaccine and Vaccine Administration
Section 7.7-B -
COVID 19 Testing
Section 7.7-C -
COVID-19 Treatment
Surgeon General
Evelyn Griffin, MD
Secretary
Bruce D. Greenstein
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Cicero Government
Medicaid
For Medicaid Partners
Medicaid State Plan
Medicaid State Plan
State Plan Amendments
LaCHIP State Plan and Amendments
A Medicaid State Plan is a set of rules that the state uses to provide Medicaid health insurance to people who need it. Each state has its own plan that follows federal guidelines, but can also make some choices about how the program works. The plan details who is eligible for Medicaid, what services are covered, and how the state will pay for those services.
Section 1 - Single State Agency Organization
Section 1.1 -
Designation and Authority
Attachment 1.1a -
Certification of Single State Agency
Section 1.2 - Organization for Administration
Attachment 1.2a -
State Agency Organization and Functions
Attachment 1.2b -
Organization and Function of Bureau of Health Services Financing
Attachment 1.2c -
Professional Medical and Supporting Staff
Attachment 1.2d -
Description of Staff Making Eligibility Decisions
Section 1.3 -
Statewide Operation
Section 1.4 -
State Medical Care Advisory Committee
Section 1.5 -
Pediatric Immunization Program
Section 1.6 -
Tribal Consultation of SPA Process
Section 2 - Coverage and Eligibility
Section 2.1 -
Application Determination of Eligibility and Furnishing Medicaid
Section 2.2 -
Coverage and Conditions of Eligibility
Attachment 2.2a -
Groups Covered and Agencies Responsible for Eligibility
Supplement 1 -
Reasonable Classifications of Individuals
Section 2.3 -
Residence
Section 2.4 -
Blindness
Section 2.5 -
Disability
Section 2.6 -
Financial Eligibility
Attachment 2.6A
Eligibility Conditions and Requirements
Supplement 1 -
Eligibility Income Levels
Supplement 2 -
Eligibility Resource Levels
Supplement 3 -
Reasonable Limits
Supplement 5 -
Methodologies for Treatment of Income and Resources that Differ from SSI
Supplement 5a -
Methodologies for Treatment of Resources for Individuals with Income up to a Percentage of FPL
Supplement 6 -
Standards for Optional State Supplementary Payments
Supplement 7 -
Categorically Needy who are Covered under Requirements more Restrictive than SSI
Supplement 8a -
More Liberal Methods of Treating Income under 1902(r)(2) of the Act
Supplement 8b -
More Liberal Methods of Treating Resources under 1902(r)(2) of the Act
Supplement 8c -
State Long-Term Care Insurance Partnership
Supplement 9 -
Transfer of Resources
Supplement 9a -
Transfer of Assets
Supplement 10 -
Consideration of Medicaid Qualifying Trusts - Undue Hardship
Supplement 12 -
Variations from the Basic Personal Needs Allowance
Supplement 13 -
Section 1924 Provisions
Supplement 14 -
Income and Resource Requirements for Tuberculosis Infected Individuals
Supplement 15 -
Treatment of Optional Groups of Qualified Aliens
Supplement 16 -
Eligibility under Section 1931 of the Act
Supplement 17 -
Disqualification for Long-Term Care Assistance for Individuals with Substantial Home Equity
Supplement 18 –
Federal Medical Assistance Percentage (FMAP)
Section 2.7 -
Medicaid Furnished Out of State
Section 2.8 -
Modified Adjusted Gross Income (MAGI)
Section 2 - MMDL and MACPro System Approvals
MACPro -
General Eligibility Requirements - Application
MACPro - Eligibility and Enrollment Processes
Continuous Eligibility for Children
Continuous Eligibility for Pregnant Women and Extended Postpartum Coverage
MACPro – Eligibility Groups – Mandatory Coverage
Former Foster Care Children
Qualified Medicare Beneficiaries
Qualified Disabled and Working Individuals
Specified Low Income Medicare Beneficiaries
Qualifying Individuals
MACPro – Eligibility Groups – Optional Coverage
Children under Age 19 with a Disability
Age and Disability-Related Poverty Level
Individuals Eligible for Cash Except for Institutionalization
Individuals in Institutions Eligible under a Special Income Level
Medically Needy Population Based on Age, Blindness or Disability
Medically Needy
Optional Eligibility Groups
PACE Participants
Ticket to Work Basic
MACPro - General Administration
Reporting - Child and Adult Core Sets
OneMAC and MMDL SPAs
A1 - A3 Medicaid Administration
CS20 – SCHIP Non-Financial Eligibility – Substitution of Coverage
CS21 - CHIP Non-Financial Eligibility - Non-Payment of Premiums
CS31 - Incarcerated CHIP Beneficiaries
S10 - MAGI-Based Income Methodologies
S14 - AFDC Income Standards
S21 - Presumptive Eligibility by Hospitals
S25 - Mandatory Coverage - Parents and Other Caretaker Relatives
S28 - Mandatory Coverage - Pregnant Women
S30 - Mandatory Coverage - Infants and Children Under Age 19
S32 - Mandatory Coverage - Adult Group
S50 - Options for Coverage - Individuals above 133 FPL
S51 - Options for Coverage - Optional Coverage of Parents and Other Caretaker Relatives
S52 - Options for Coverage - Reasonable Classification of individuals Under Age 21
S53 - Options for Coverage - Children with Non IV-E Adoption Assistance
S54 - Options for Coverage - Optional Targeted Low Income Children
S55 - Options for Coverage - Individuals with Tuberculosis
S57 - Options for Coverage - Independent Foster Care Adolescents
S59 - Options for Coverage - Individuals Eligible for Family Planning Services
S88 - Non-Financial Eligibility State Residency
S89 - Non-Financial Eligibility Citizenship and Non-citizen Eligibility
S94 - General Eligibility Requirements - Eligibility Process
Section 3 - Services: General Provisions
Section 3.1 -
Amount, Duration and Scope of Services
Attachment 3.1a -
Amount Duration and Scope of Services for Categorically Needy
Item 1 -
Inpatient Hospital Services
Item 2a -
Outpatient Hospital Services
Item 2b -
Rural Health Clinic Services
Item 2c -
FQHC Services
Item 3 -
Other Laboratory and X-Ray Services
Item 4a -
Skilled Nursing and Surgical Services for Individuals 21 or Older
Item 4b -
EPSDT Services
Item 4c -
Family Planning
Item 5 -
Physician Services
Item 5b -
Medical and Surgical Services Furnished by a Dentist
Item 6 -
Medical and Remedial Care Furnished by Other Licensed Practitioners
Item 7 -
Home Health Care Services
Item 9 -
Clinic Services
Item 12a -
Prescribed Drugs
Item 12b -
Dentures
Item 12c -
Prosthetic Devices
Item 13c -
Preventive Services
Item 13d -
Rehabilitative Services
Item 14a -
Services for Individuals 65 or older in Institutions for Mental Diseases
Item 15 -
Intermediate Care Facility Services
Item 16 -
Inpatient Psychiatric Facility Services for Under 21
Item 17 -
Nurse Midwife Services
Item 18 -
Hospice Care Services
Item 19 -
Targeted Case Management Services
Item 19b -
Special Tuberculosis-Related Services for Tuberculosis Infected Individuals
Item 20a -
Pregnancy Related and Postpartum Services
Item 20b -
Extended Services for Pregnant Women
Item 23 -
Nurse Practitioner Services
Item 24a -
Medical Transportation Services
Item 24d -
Skilled Nursing Facility Services for Individuals Under 21
Item 26 -
Personal Care Services
Supplement 1 -
Targeted Case Management
Supplement 2 -
Self-Directed Personal Assistance Services
Supplement 3 -
PACE
Supplement 4 -
Medication-Assisted Treatment
Attachment 3.1b -
Amount, Duration and Scope of services Provided to Medically Needy Groups
Attachment 3.1c -
Standards and Methods for Assuring High Quality Care
Attachment 3.1d -
Methods of Providing Transportation
Attachment 3.1e -
Standards for Coverage of Organ Transplants
Attachment 3.1f -
Managed Care
Attachment 3.1m -
Mandatory Coverage for Eligible Juveniles Who are Inmates
Section 3.2 -
Coordination of Medicaid with Medicare and Other Insurance
Attachment 3.2a -
Coordination of Medicare
Section 3.3 -
Medicaid for Individuals 65 or Over in Institutions for Mental Disease
Section 3.4 -
Special Requirements Applicable to Sterilization Procedures
Section 3.5 -
Families Receiving Extended Medicaid Benefits
Section 3.6 -
Additional Amounts for Nursing Facility Residents
Section 3 - MMDL System Approvals
Alternative Benefit Plan (ABP)
ABP1 - Alternative Benefit Plan Populations
ABP2a - Voluntary Benefit Package Selection Assurances - Eligibility Group Under 1902
ABP3 - Selection of Benchmark Benefit Package or Benchmark-Equivalent Benefit Package
ABP4 - Alternative Benefit Plan Cost-Sharing
ABP5 - Benefits Description
ABP7 - Benefits Assurances
ABP8 - Service Delivery Systems
ABP9 - Employer Sponsored Insurance and Payment of Premiums
ABP11 - Payment Methodology
Section 4 - General Program Administration
Section 4.1 -
Methods of Administration
Section 4.2 -
Hearings for Applicants and Recipients
Attachment 4.2a -
Fair Hearings
Section 4.3 -
Safeguarding Information on Applicants and Recipients
Section 4.4 -
Medicaid Quality Control
Section 4.5 -
Medicaid Agency Fraud Detection and Investigation Program
Section 4.6 -
Reports
Section 4.7 -
Maintenance of Records
Section 4.8 -
Availability of Agency Program Manuals
Section 4.9 -
Reporting Provider Payments to the IRS
Section 4.10 -
Free Choice of Providers
Section 4.11 -
Relations with Standard-Setting and Survey Agencies
Attachment 4.11a -
Standards for Institutions
Section 4.12 -
Consultation to Medical Facilities
Section 4.13 -
Required Provider Agreement
Section 4.14 -
Utilization Control
Attachment 4.14b -
Utilization Review Methods for Intermediate Care Facilities
Section 4.15 -
Inspections of Care in Skilled Nursing and Intermediate Care Facilities and Institutions for Mental Disease
Section 4.16 -
Relations with State Health and Vocational Rehab Agencies and Title V Grantees
Attachment 4.16a -
Interrelations with State Health and Vocational Rehab Agencies and Title V Grantees
Section 4.17 -
Liens and Adjustments or Recoveries
Attachment 4.17a -
Liens and Adjustments or Recoveries
Section 4.18 - Medicaid Premiums and Cost Sharing
Attachment 4.18
G1 –
Cost Sharing Requirements
G2a –
Cost Sharing Amounts – Categorically Needy Individuals
G2b –
Cost Sharing Amounts – Medically Needy Individuals
G2c –
Cost Sharing Amounts – Targeting
G3 –
Cost Sharing Limitations
Section 4.19 -
Payment for Services
Attachment 4.19a
Item 1 -
Inpatient Hospital Services Reimbursement
Item 14a -
Services for Individuals 65 or Older in Institutions for Mental Diseases
Item 16 -
Inpatient Psychiatric Hospital Services for Individuals Under Age 21
Attachment 4.19b
Item 2a -
Outpatient Hospital Services
Item 2b -
Rural Health Clinic Services
Item 2c -
FQHC Services
Item 2d -
Reimbursement for Indian Health Services Tribal 638 Facilities
Item 3 -
Other Laboratory and X-Ray Services
Item 4b -
EPSDT Services
Item 4c -
Family Planning Services and Supplies for Individuals of Child Bearing Age
Item 5 -
Physician Services
Item 5b -
Medical and Surgical Services Provided by a Dentist
Item 6 -
Medical and Remedial Care Furnished by Other Licensed Providers
Item 7 -
Home Health Care Services
Item 9 -
Clinic Services
Item 12a -
Prescribed Drugs
Item 12b -
Dentures
Item 12c -
Prosthetic Devices
Item 13c -
Preventive Services
Item 13d -
Rehabilitative Services
Item 17 -
Nurse Midwife Services
Item 18 -
Hospice Care Services
Item 19 -
Targeted Case Management Services
Item 19b -
Special Tuberculosis-related Services for Tuberculosis Infected Individuals
Item 20a -
Pregnancy-related and Postpartum Services
Item 20b -
Extended Services for Pregnant Women
Item 23 -
Nurse Practitioner Services
Item 24a -
Medical Transportation Services
Item 24d -
Skilled Nursing Facility Services for Individuals under 21
Item 26 -
Personal Care Services
Item 28 -
Self-directed Personal Assistance Services
Item 28(i) -
Free-Standing Birthing Centers
Item 29 -
Medication-Assisted Treatment
Item 30 –
Qualifying Clinical Trials
Supplement 1 -
Payment Rates for Title XIII Part A and Part B Deductible/Coinsurance
Attachment 4.19c -
Methods of Payment for Reserving Beds During a Recipients Absence from an Inpatient Facility
Attachment 4.19d(1) -
Payments for Skilled Nursing Facilities
Attachment 4.19d(2) -
Payments for Intermediate Care Facilities
Attachment 4.19e -
Timely Claims Payment - Definition of Claim
Section 4.20 -
Direct Payment to Certain Recipients for Physician or Dentist Services
Section 4.21 -
Prohibition Against Reassignment of Provider Claims
Section 4.22 -
Third Party Liability
Attachment 4.22a -
Requirements for Third Party Liability - Identifying Liable Resources
Attachment 4.22b -
Requirements for Third Party Liability - Payment of Claims
Attachment 4.22c -
Requirements for Third Party Liability - Cost Effectiveness for Employer Based Group Health Benefit Plans
Supplement 1 -
State Laws Requiring Third Parties to Provide Coverage Eligibility and Claims Data
Section 4.23 -
Use of Contracts
Section 4.24 -
Standards for Payments for Skilled Nursing and Intermediate Care Facility Services
Section 4.25 -
Program for Licensing Administrators of Nursing Homes
Section 4.26 -
Drug Utilization Program
Section 4.27 -
Disclosure of Survey Information and Provider or Contractor Evaluation
Section 4.28 -
Appeals Process for Skilled Nursing and Intermediate Care Facility Services
Section 4.29 -
Conflict of Interest Provisions
Section 4.30 -
Exclusion of Providers and Suspension of Practitioners and Other Individuals
Attachment 4.30 -
Sanctions for Psychiatric Hospitals
Section 4.31 -
Disclosure of Information by Providers and Fiscal Agents
Section 4.32 -
Income and Eligibility Verification System
Attachment 4.32a -
Income and Eligibility Verification System Procedures - Requests to Other State Agencies
Section 4.33 -
Medicaid Eligibility Cards for Homeless Individuals
Attachment 4.33a -
Method for Issuance of Medicaid Eligibility Cards to Homeless Individuals
Section 4.34 -
Systematic Alien Verification for Entitlements
Attachment 4.34a -
Requirements for Advance Directives
Section 4.35 -
Enforcement of Compliance for Nursing Homes
Attachment 4.35a -
Enforcement of Compliance for Nursing Facilities
Section 4.36 -
Required Coordination Between Medicaid and WIC Programs
Section 4.38 -
Nurse Aide Training and Competency Evaluation for Nursing Facilities
Attachment 4.38 -
Collection and Disclosure of Additional Registry Information
Section 4.39 -
Pre-admission Screening and Annual Resident Review in Nursing Facilities
Attachment 4.39 -
Definition of Specialized Services
Attachment 4.39a -
Categorical Determinations
Section 4.41 -
Resident Assessment for Nursing Facilities
Section 4.42 -
Employee Education About False Claims Recoveries
Attachment 4.42a -
Method of Compliance Oversight and Frequency with which the State will Reassess Compliance
Section 4.43 -
Cooperation with Medicaid Integrity Program Efforts
Section 4.44 -
Prohibition on Payments to Institutions or Entities Located Outside the U.S.
Section 4.46 -
Provider Screening and Enrollment
Section 5 - Personnel Administration
Section 5.1 -
Standards of Personnel Administration
Section 5.2 -
Reserved
Section 5.3 -
Training Programs - Sub-professional and Volunteer Programs
Section 6 - Financial Administration
Section 6.1 -
Fiscal Policies and Accountability
Section 6.2 -
Cost Allocation
Section 6.3 -
State Financial Participation
Section 7 - General Provisions
Section 7.1 -
Plan Amendments
Section 7.2 -
Non-discrimination
Attachment 7.2a -
Methods of Administration - Compliance with Civil Rights Act (Title VI)
Section 7.4 -
State Governor's Review
Section 7.4.A -
Rescissions to Medicaid Disaster Relief COVID-19 National Emergency
Section 7.4.B - Temporary Extensions to the Disaster Relief Policies for the COVID-19 National Emergency
23-0015 LA Medicaid Disaster Relief SPA Signature Waiver (Pharmacy)
23-0019 Long Term-Personal Care Services Disaster Relief Extension
23-0023 Disaster Relief Extension SPA (Long Term-Personal Care Services)
23-0030 Medicaid Disaster Relief Extension (Treatment in Place)
Section 7.4.C - Temporary Policies in Effect Following the COVID-19 National Emergency
23-0017 Targeted Case Management
23-0018 Disaster Relief Extension (Long Term - Personal Care Services)
Section 7.4.1 -
Medicaid Disaster Relief COVID-19 National Emergency
Medicaid Disaster Relief Increase Reimbursement Vaccine Administration
Medicaid Disaster Relief Laboratory Services
Medicaid Disaster Relief Administrative Claiming
Medicaid Disaster Relief FQHC and RHC - Alternative Payment Methodology
Medicaid Disaster Relief FQHC and RHC - Alternative Payment Methodology COVID-19 Monoclonal Treatment
Medicaid Disaster Relief SPA - ICF-IID Direct Care Add-On
Medicaid Disaster Relief SPA – Home and Community-Based Services Spending Plan – Targeted Case Management and Personal Care Services
Medicaid Disaster Relief SPA – Home and Community-Based Services - Personal Care Services
Section 7.7 -
COVID-19 Vaccine and Vaccine Administration, Testing, and Treatment
Section 7.7-A -
COVID-19 Vaccine and Vaccine Administration
Section 7.7-B -
COVID 19 Testing
Section 7.7-C -
COVID-19 Treatment
Surgeon General
Evelyn Griffin, MD
Secretary
Bruce D. Greenstein
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