Louisiana Administrative Code

A. The Medicaid Program hereby adopts provisions to provide coverage under the Medicaid State Plan for substance use disorders (SUD) services rendered to children and adults. These services shall be administered under the authority of the Department of Health (LDH), in collaborat…

A. Children and adults who meet Medicaid eligibility and clinical criteria shall qualify to receive medically necessary SUD services. B. Qualifying children and adults with an identified SUD diagnosis shall be eligible to receive SUD services covered under the Medicaid state plan…

A. The purpose of Regulation 100 is to implement Act 350 of the 2011 Regular Session of the Louisiana Legislature pertaining to the coverage of prescription drugs through a drug formulary as set forth in R.S. 22:1060.1 et seq. which provides for the continuation of drug coverage …

A. Regulation 100 is promulgated pursuant to the authority granted in R.S. 22:11, R.S. 22:1068F and R.S. 22:1074F.

A. Regulation 100 applies to all health insurance issuers as well as health maintenance organizations as defined by R.S.22:1060.1(6).

A. Definitions. As used in Regulation 100, the following terms shall have the meaning or definition as indicated herein. Commissioner—commissioner of insurance for the state of Louisiana. Enrollee—any individual, including a dependent, who is enrolled or insured by a health insur…

A. There shall be three different and distinct types of notice that a health insurance issuer is required to provide to every applicable enrollee. Each notice shall be filed with and approved by the Department of Insurance prior to use in Louisiana. B. Notice and Disclosure of Dr…

A. A modification affecting drug coverage shall mean any of the following: 1. removing a drug from a formulary; 2. adding a requirement that an enrollee receive prior authorization for a drug; 3. imposing or altering a quantity limit for a drug; 4. imposing a step-therapy restric…

A. The refusal of a health insurance issuer to provide benefits to an enrollee for a prescription drug is an adverse determination for the purposes of Subpart F of Part III of Chapter 4 of the Louisiana Insurance Code, R.S. 22:1121 et seq., relative to medical necessity review or…

A. Pursuant to R.S. 22:1068, a health insurance issuer may modify its drug coverage offered to a group health plan if each of the following conditions is met. 1. The modification occurs at the time of coverage renewal. 2. The modification is approved by the commissioner. However,…

A. Pursuant to R.S. 22:1074, a health insurance issuer may modify its drug coverage offered to individuals if each of the following conditions is met. 1. The modification occurs at the time of coverage renewal. 2. The modification is approved by the commissioner. However, modific…

A. To facilitate the ability of the commissioner to comply with his statutory duty, the commissioner shall have the authority to enter into a contract with any person or entity he deems applicable, relevant and/or appropriate to provide advice and/or make a recommendation to the …

This regulation shall be effective upon final publication in the Louisiana Register.

A. The self-direction initiative is a voluntary, self-determination option which allows the beneficiary to coordinate the delivery of NOW services, as designated by OCDD, through an individual direct support professional rather than through a licensed, enrolled provider agency. S…

A. Effective for dates of service on or after August 1, 2015, New Opportunities Waiver providers shall use the electronic visit verification (EVV) system designated by the department for automated scheduling, time and attendance tracking, and billing for certain home and communit…

A. The direct service provider is responsible for responding to, reviewing, and remediating incidents that occur to the beneficiaries they support. Direct service providers must comply with any other rules promulgated by the LDH regarding incident reporting and response.

A. Reimbursement for services shall be a prospective flat rate for each approved unit of service provided to the beneficiary. One-quarter hour (15 minutes) is the standard unit of service and reimbursement shall not be made for less than 15 minutes (one-quarter hour) of service. …

A. All SUD services must be medically necessary. The medical necessity for services shall be determined by a licensed mental health practitioner (LMHP) or physician who is acting within the scope of his/her professional license and applicable state law. B. American Society of Add…

A. The following SUD services shall be reimbursed under the Medicaid Program: 1. assessment; 2. outpatient treatment; 3. residential treatment; and 4. inpatient treatment. B. Service Exclusions. The following services/components shall be excluded from Medicaid reimbursement: 1. c…

A. Each provider of SUD services shall enter into a contract with one or more of the managed care organizations (MCOs) and with the Coordinated System of Care (CSoC) contractor for youth enrolled in the Coordinated System of Care program in order to receive reimbursement for Medi…

A. The purpose and intent of Regulation 102 is to exercise the authority and fulfill the duties and responsibilities of the commissioner with respect to the continued regulation of professional employer organizations (“PEOs”). Regulation 102 delineates the qualifications of appro…

A. Regulation 102 is promulgated pursuant to the authority of the commissioner under R.S.22:11, R.S. 22:1750, R.S. 22:1751, and pursuant to the authority and powers granted by law to the commissioner and the department.

A. Regulation 102 applies to any assurance organization that transacts business on behalf of a professional employer organization authorized to operate in the state of Louisiana. A professional employer organization shall not be required to utilize the services of an approved ass…

A. Any assurance organization that intends to be approved by the commissioner for authorization to transact business on behalf of a professional employer organization in the state of Louisiana shall apply for and obtain the approval of the commissioner. B. To be considered for ap…

A. For each professional employer organization that chooses to be represented by an approved assurance organization, the approved assurance organization shall submit to the department an application, executed by the professional employer organization, requesting that the assuranc…

A. An assurance organization that has been approved by the commissioner shall obtain authorization from the accredited professional employer organization and shall release to the department confidential information in support of each accredited professional employer organization’…

A. Provided the approved assurance organization remains in compliance with Regulation 102, the approval issued by the commissioner to an assurance organization shall remain in effect until the assurance organization withdraws from the state or until approval is suspended or revok…

A. Upon the approval of an assurance organization, the commissioner shall: 1. issue a letter to the assurance organization notifying it that it meets the requirements of Regulation 102; and 2. include the assurance organization on the list of approved assurance organizations that…

A. If any provision of Regulation 102 or its application to any person or entity or any circumstance of its application is held invalid, such invalidity shall not affect other provisions or applications of Regulation 102 which can be given effect without the invalid provision or …

A. This regulation shall become effective on January 1, 2015 after final publication in the Louisiana Register.

A. For recipients enrolled with the CSoC contractor, the department or its fiscal intermediary shall make monthly capitation payments to the CSoC contractor, exclusive of coverage for residential substance use treatment services. 1. The capitation rates paid to the CSoC contracto…

A. Effective for dates of service on or after July 1, 2012, the reimbursement rates for outpatient SUD services provided to children/adolescents shall be reduced by 1.44 percent of the rates in effect on June 30, 2012.

A. Regulation 106 implements the provisions of Act 844, of the 2014 Regular Session of the Louisiana Legislature, specifically R.S. 22:1964 (28) which mandates that the Department of Insurance promulgate rules and/or regulations addressing the replacement of limited benefit insur…

A. Regulation 106 shall apply to transactions in the individual market involving existing limited benefit polices and the new sale of limited benefit insurance policies where it is known or should be known to the producer, or to the insurer if there is no producer that the sale o…

A. Regulation 106 is promulgated by the commissioner pursuant to the authority granted under the Insurance Code, R.S. 22:1 et seq., particularly R.S. 22:11, and specifically R.S. 22:1964 (28).

A. For the purposes of Regulation 106 the following terms shall have the meaning ascribed herein unless the context clearly indicates otherwise. Commissioner—the Commissioner of Insurance of the Louisiana Department of Insurance. Existing Policy—an in-force limited benefit insura…

A. Unless otherwise specifically included, this regulation shall not apply to transactions involving: 1. group and blanket group limited benefit policies; 2. medicare supplement policies; 3. long term care policies.

A. An application form submitted by an insurer or his producer for a limited benefits policy shall include a question designed to elicit information as to whether the insurance to be issued is intended to replace any other limited benefit insurance policy presently in force. 1. I…

A. Direct response insurers shall deliver to the applicant, upon acceptance of the application and prior to the issuance of the policy, the notice described in Appendix B or other substantially similar form notice approved by the Commissioner of Insurance.

A. Any failure to comply with this regulation shall be considered a violation of R.S. 22:1964. Violations of this regulation shall subject the violators to penalties as provided by R.S. 22:1969, 1970 and any other applicable provisions of law.

A. Regulation 106 shall become effective upon final publication in the Louisiana Register and shall apply to any act or practice committed on or after the effective date.

A. If any Section or provision of Regulation 106 or the application to any person or circumstance is held invalid, such invalidity or determination shall not affect other Sections or provisions or the application of Regulation 106 to any persons or circumstances that can be given…

Notice to Applicant Regarding Replacement of Limited Benefit Insurance According to [your application] [information you have furnished], you intend to lapse or otherwise terminate existing limited benefit insurance and replace it with a policy to be issued by [insert company name…

Notice to Applicant Regarding Replacement of Limited Benefit Insurance According to [your application] [information you have furnished], you intend to lapse or otherwise terminate existing limited benefit insurance and replace it with a policy to be issued by [insert company name…

A. Applications for specific licenses shall be filed on a form prescribed by the Office of Environmental Compliance or in any other manner specified by the department. B. The department may at any time after the filing of the original application, and before the expiration of the…

A. The Louisiana Department of Transportation and Development (DOTD) recognizes that landowners have certain rights of access. The DOTD also recognizes that access connections are a major contributor to traffic congestion, increase the degradation of transportation facility opera…

Access Connection Permits⎯shall be defined and required as follows: 1. single-family residential access connections: a. single family residential⎯1 to 5 homes on a single access connection (Six or more residences on a single shared access or a single property subdivided for multi…

A. Public road or street connections shall follow the normal project development process and shall only be requested by the local authority within the jurisdiction over the roadway.

A. Facilities requiring access connection permits may be either new facilities or existing facilities which are remodeled, undergo a change of use, or any other change(s) to the operations of the facility.

A. The applicant agrees to hold harmless the DOTD and its duly appointed agents and employees against any action for personal injury or property damage sustained by reason of the exercise of a permit, whether or not the same may have been caused by the negligence of the DOTD, its…