Louisiana Administrative Code

A. The board shall appoint a member to fill any active member vacancy created on the board. The appointee shall possess the necessary qualifications under R.S. 11:511 for the active member position. The board may give due consideration to the runners-up in the previous election, …

A. Because optional retirement plan participants do not acquire service credit for purposes of determining eligibility under R.S. 11:511(4), these participants are not eligible to vote in the trustee elections or run for a position on the board of trustees.

A. The purpose of this Rule is to provide a legal framework for electronic billing, processing, and payment of medical services and products provided to an injured employee and data reporting subject to R.S. 23:1203.2. It is the goal of the OWCA that electronic billing in Louisia…

A. For the purposes of this Rule the following definitions shall apply. Agent—broadly construed to mean any person or entity that performs medical bill related processes for the insurance carrier responsible for the bill. These processes include, but are not limited to, reporting…

A. Where mandated for insurance carriers, beginning July 1, 2013 for electronic transmissions, the following electronic medical bill processing standards shall be used. 1. Billing a. Professional Billing—the ASC X12 Standards for Electronic Data Interchange Technical Report Type …

A. Introduction and Overview 1. HIPAA a. The Administrative Simplification Act provisions of the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA, Title II) include requirements that national standards for electronic health care transactions and national…

A. Billing codes and modifier systems identified below are valid codes for these workers’ compensation transactions, in addition to any code sets defined by the standards adopted in Section 305. 1. "CDT-4 Codes"—codes and nomenclature prescribed by the American Dental Association…

A. Applicability 1. This Section outlines the exclusive process to exchange electronic medical bill and related payment processing data for professional, institutional/hospital, pharmacy, and dental services. This Section does not apply to requests for reconsideration or judicial…

A. Upon receipt of medical bills submitted in accordance with Sections 305, 307, and 309 of this Chapter, an insurance carrier shall evaluate each bill’s conformance with the criteria of a complete medical bill. B. The received date of an electronic medical bill is the date all o…

A. Any communication between the health care provider and the insurance carrier related to medical bill processing shall be of sufficient specific detail to allow the responder to easily identify the information required to resolve the issue or question related to the medical bil…

A. Medical documentation includes all medical reports and records permitted or required in accordance with Title 40 of the Louisiana Administrative Code. B. Any request by the insurance carrier for additional documentation to process a medical bill shall conform to the requiremen…

A. Any electronically submitted bill determined to be complete but not paid or objected to within 60 days shall be subject to penalties per R.S. 1201(F).

A. This Chapter applies to all medical services and products provided on or after July 1, 2013 for medical services and products provided prior to July 1, 2013, medical billing and processing shall be in accordance with the rules in effect at the time the health care was provided…

A. Leased employees or persons considered by the system as leased employees of an employer shall not be eligible to participate. Leased employee shall mean any person who is not employed by an employer and pursuant to an agreement between the employer and any other person or enti…

A. When a declared disaster occurs and recipients relocate out of state due to the declared disaster, Medicaid coverage of the services they are receiving in home and community-based waivers, shall be terminated under either of the following circumstances: 1. the participant fail…

A. If a member takes a leave of absence to serve in the U.S. armed services, the terms of which are governed by the Uniformed Services Employment and Reemployment Rights Act (USERRA), then upon the member's return to employment with the employer within five years from the leave o…

A. Any active duty member of the armed forces who has been temporarily assigned to work outside of Louisiana, and any member of his/her immediate family who has qualified for and received home and community-based waiver services provided under the Medicaid Program for persons wit…

A. Home and community-based providers shall report to the operating agency when/if it becomes known to the agency that a participant’s status has changed such that the participant no longer meets programmatic or financial eligibility requirements.

A. To be eligible for compensation, an individual must have suffered personal injury, death or catastrophic property loss as a result of a violent crime. 1. Victim Conduct and Behavior a. The Crime Victims Reparations Board may vote to deny or reduce an award to a claimant who is…

A. Claimant Responsibility 1. Applications for reparations must be submitted to the sheriff’s office in the parish where the crime occurred, filed online at the board’s website, or sent directly to the board’s office. Applications involving an adult victim of a sexually-oriented …

A. The Medicaid reimbursement for ground ambulance services is the rate established in the state fee schedule for emergency ambulance transport, basic life support, advanced life support and mileage, oxygen, intravenous fluids, and disposable supplies administered during the emer…

A. Effective for dates of service on or after September 20, 2011, quarterly supplemental payments shall be issued to qualifying ambulance providers for emergency medical transportation services rendered during the quarter if the department has received an appropriation from the l…

A. Emergency Medical Transportation 1. Qualifying emergency ambulance service providers assessed a fee as outlined in LAC 48:I.4001.E.1.a-b shall receive enhanced reimbursement for emergency ground ambulance transportation services rendered during the quarter through the Suppleme…

A. Rotor winged (helicopters) and fixed winged emergency aircraft must be certified by the Department of Health, Bureau of Health Services Financing in order to receive Medicaid reimbursement. All air ambulance services must be provided in accordance with state laws and regulatio…

A. Fixed Winged Air Ambulance. The reimbursement for fixed winged air ambulance services is the Medicare base rate plus mileage in effect as of January 1, 1995. 1. Payment for air mileage is limited to actual air mileage from the point of pick-up to the point of delivery of the p…

A. Effective for dates of service on or after September 20, 2011, quarterly supplemental payments shall be issued to qualifying ambulance providers for emergency medical air transportation services rendered during the quarter if the department has received an appropriation from t…

A. During a declared emergency or disaster by the governor, the commission may delegate authority to the director for the purposes of waving any rule under Part IX of Title 55 that does not materially affect safety. B. The delegation shall be by majority vote of the commission. C…

A. A sample agreement for coverage shall be posted on the MERS website. B. Employers are not required to use the sample agreement so long as any agreement for coverage submitted to the board of trustees for approval contains each of the elements specified in R.S. 11:1733. C. An e…

A. By virtue of the authority vested in the administrator of the Louisiana Workforce Commission of the state of Louisiana by the Louisiana Employment Security Law, R.S. 23:1471-1713 (Act 97 of 1936), as amended, and in order to establish uniform procedure under said law, the foll…

A. Prior to participation in any claim resolution, newly hired administrative law judges will participate in web-based and/or in-person training on: agency policy and precedent, benefits analysis, the unemployment insurance system, the appeals process, and the proper methods for …

A. All employers shall follow the instructions issued them by the administrator relative to the posting and maintaining in prominent locations in their places of business where they may be read by the public and all workers, such cards, statements and materials relating to unempl…

A. Accrual and Due Date of Contributions. Contributions due on wages paid shall become due and shall be paid on or before the last day of the month following the calendar quarter in which such contributions accrue. B. Interest. Interest prescribed by law on all overdue contributi…

A. Each employing unit shall comply with instructions pertaining to the contents and due date of any report issued or required by the administrator.

A. Each employing unit shall establish records with respect to employment performed for it as hereinafter indicated and shall preserve such records, including those now existing for a period of not less than five years after the calendar year in which the remuneration with respec…

A. Any employing unit who pays wages to a worker within this state, or who pays wages to a worker for work performed in this state, or pays wages to a worker who is domiciled in this state, must, within 30 days of the first payment to a worker in this state or for work performed …

A. Each worker engaged in employment for an employer shall procure a federal Social Security account number and report it to every employer by whom he is employed. B. Each employer shall ascertain the federal Social Security account number of each worker employed by him in employ…

A. Individual Separation Notices 1. Under Conditions Which May Disqualify. Whenever a worker is separated from his employment permanently or for an indefinite period or for an unexpected duration of seven or more days, under conditions which may disqualify him for benefits pursua…

A. When the employer or the employer’s agent receives the notice specified by R.S. 23:1624 of a claimant’s eligibility for benefits or other notice that an application for benefits has been made; the employer or employer’s agent shall, within the time specified in the notice exam…

A. The term: 1. week⎯a calendar week; 2. calendar week⎯the seven consecutive days commencing at 12:01 a.m. on Sunday and ending at midnight on Saturday. B Week of Total or Part-Total Unemployment 1. A week of total or part-total unemployment⎯the seven-consecutive-day period comme…

A. Total Unemployment. A totally unemployed individual is one who, during any week, performs no services and in which no wages are payable to him. B. Partial Unemployment 1. A partially unemployed individual is one who, during a particular week, earned less than his weekly benefi…

A. Claims for benefits for total or part-total unemployment shall be made on forms prescribed by the administrator for that purpose. In order to claim benefits or waiting period credits for unemployment, an individual shall: 1. file a claim for benefits. B. The continued claim fo…

A. Employer Responsibility in the Initiation of a First Claim for Partial Benefits in a Benefit Year 1. Immediately after the termination of any calendar week in which a worker earned less than 60 percent of his customary full-time weekly wage due to lack of work, his employer sh…

A. A witness attending an appeal hearing in obedience to R.S. 23:1631 shall be reimbursed his necessary traveling expenses in conformity with agency travel regulations. The regulation shall not be construed as allowing witness fees or mileage to any party interested in the appeal…

A. Benefit payments shall be made to the claimant by electronic funds transfer to his bank account, by debit card, check, or other electronic means. Supplemental payments may, in the discretion of the administrator, be made by check, automatic clearing house (ACH), or electronic …

A. Interstate claims will be administered under arrangements entered into by the administrator with the appropriate agencies of other states or of the United States in accordance with R.S. 23:1666 of the Louisiana Employment Security Law.

A. Louisiana employers shall be charged or noncharged in cases where Louisiana transfers wages earned with Louisiana employers to another state in order that that state pay unemployment compensation benefits. B. The Louisiana employer will be notified of their potential liability…

A. The following regulations, adopted under R.S. 23:1665 of the Louisiana Employment Security Law, shall govern Louisiana Workforce Commission in its administrative cooperation with other states subscribing to the interstate reciprocal coverage arrangement, herein referred to as …

A. The heirs of a deceased benefit claimant may make application by submitting a formal affidavit of heirship, to have paid to them all moneys due the deceased at the time of his death. Affidavits must be submitted by all heirs of full age and majority, or if there be minor heirs…

A. The transfer of experience-rating records to employers who acquired a segregable and identifiable portion of a predecessor's business within the meaning of R.S. 23:1539 shall be affected on the following basis. 1. Where the business or unit acquired can be completely segregate…

A. Pay Period. For the purpose of this regulation the term "pay period" established by "Shipping Articles" means the period of the voyage or engagement of the crew under "Articles of Agreement" pursuant to Title 46 of the United States Code. B. Current Reports. Notwithstanding an…