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LOUISIANA DEPARTMENT OF HEALTH & HOSPITALS
MEDICAID SERVICES CHART
September 2012
NOTE: The information listed in this document is applicable to Medicaid recipients in the fee-for-service Medicaid program. Bayou Health Plan members
should contact their plan’s member services with questions about how to access care (https://bayouhealth.com/LASelfService/en_US/plans.html).
MEDICAID SERVICES
HOW TO
CONTACT
SERVICE ACCESS ELIGIBILITY COVERED SERVICES COMMENTS
PERSON
SERVICES
Adult Denture Dentist Medicaid recipients 21 years of age Dentures, denture relines, and All services other than repairs require
Services and older. denture repairs. Prior Authorization. The provider will Cordelia Clay
submit requests for the Prior 225/342-7878
(Adults, 21 and over, certified as Examination and X-rays are covered Authorization.
Qualified Medicare Beneficiary if in conjunction with the
(QMB) only, Medically Needy construction of a Medicaid- Only one complete or partial denture per
Program, or other programs authorized denture. arch is allowed in an eight-year period.
with limited benefits are not The partial denture must oppose a full
eligible for dental services.) denture. Two partials are not covered in
the same oral cavity (mouth). Additional
guidelines apply.
Appointment
Scheduling
Assistance –
See EPSDT Screening
Services
Audiological Services
–See EarlySteps;
EPSDT Screening
Services; Hospital-
Outpatient services;
Physician/
Professional Services;
Rehabilitation Clinic
Services; Therapy
Services
2
NOTE: The information listed in this document is applicable to Medicaid recipients in the fee-for-service Medicaid program. Bayou Health Plan members
should contact their plan’s member services with questions about how to access care (https://bayouhealth.com/LASelfService/en_US/plans.html).
MEDICAID SERVICES
HOW TO
CONTACT
SERVICE ACCESS ELIGIBILITY COVERED SERVICES COMMENTS
PERSON
SERVICES
Any Medicaid eligible adult may
receive the following behavioral
health service if medical necessity is
established by a licensed mental
Medicaid eligible adult health professional:
1915(i) SPA 1. Addiction Services
Adults eligible for the 1915(i) State (outpatient and residential)
Plan Amendment (SPA)Adults 2. Psychiatrist
Magellan Health eligible to receive 1915(i) State Inpatient Hospital For 1915(i) State
Darrell
Services of Plan services include those who Plan Amendment (SPA) eligible
Adult Behavioral Health services are part Montgomery
Louisiana meet one of the following criteria recipients the following additional
Behavioral Health of The Louisiana Behavioral Health 225/342-6255
1-800-424-4399 and is 21 years and older: services are available:
Services – Adults Partnership (LBHP) managed by DHH-
Visit online at
OBH (Office of Behavioral Health) Mary Norris
www.Magellanof Persons with acute stabilization 1. Case Conference
225/342-2768
Louisiana.com needs; with a MMD; meet the 2. Treatment Plan
federal definition of SMI, or who Development
has previously met the above 3. Psychosocial
criteria and needs subsequent Rehabilitation
medically necessary services for 4. Crisis Intervention
stabilization and maintenance 5. Community Psychiatric
Support & Treatment
6. Assertive Community
Treatment
7. Outpatient Therapy
Chemotherapy
Hospital
Services-See Chemotherapy administration and
Hospital-Outpatient All Medicaid Recipients. treatment drugs, as prescribed by
Physician’s office
Services; Physician/ physician.
or clinic
Professional Services
Chiropractic Services EPSDT Medical Medicaid recipients 0 through 20 Spinal manipulations. Medically necessary manual Stephanie Young
Screening years of age. manipulations of the spine when the 225/342-7878
Provider/PCP service is provided as a result of a referral
from a EPSDT medical screening provider
or Primary Care Provider (PCP).
3
NOTE: The information listed in this document is applicable to Medicaid recipients in the fee-for-service Medicaid program. Bayou Health Plan members
should contact their plan’s member services with questions about how to access care (https://bayouhealth.com/LASelfService/en_US/plans.html).
MEDICAID SERVICES
HOW TO
CONTACT
SERVICE ACCESS ELIGIBILITY COVERED SERVICES COMMENTS
PERSON
SERVICES
Any child/youth experiencing a 1. WRAP Around Planning
Magellan Health serious emotional disturbance who 2. Parent Support & Training
Darrell
Coordinated System Services of is at risk of out-of home placement. 3. Youth Support & Training
CSoC services are part of The Louisiana Montgomery
of Care (CSoC)- Louisiana A recipient must be under the age 4. Independent Living/Skills
Behavioral Health Partnership (LBHP) 225/342-6255
Home and 1-800-424-4399 of 22 and meet the level of care or Building
managed by DHH-OBH (Office of
Community Based Visit online at level of need through a Child and 5. Short Term Respite Care
Behavioral Health) Mary Norris
Services Waiver www.Magellanof Adolescent Needs and Strengths 6. Crisis Stabilization
225/342-2768
Louisiana.com (CANS) comprehensive 7. Case Conference
assessment 8. Treatment Planning
Dental Care Services
- See Adult Denture
Services; EPSDT
Dental Services; and
Expanded Dental
Services for Pregnant
Women
Durable Medical Physician All Medicaid recipients. Medical equipment and appliances such All services must be prescribed by a Sylvia Green
Equipment (DME) as wheelchairs, leg braces, etc. physician and must be Prior Authorized. 225/342-7878
Medical supplies such as ostomy
DME providers will arrange for the Prior Cynthia Bennett
supplies, etc.
Authorization request. 225/342-7878
Diapers and blue pads are not
reimbursable as durable medical
equipment items. EPSDT
RECIPIENTS ARE EXCLUDED
FROM THIS LIMITATION.
4
NOTE: The information listed in this document is applicable to Medicaid recipients in the fee-for-service Medicaid program. Bayou Health Plan members
should contact their plan’s member services with questions about how to access care (https://bayouhealth.com/LASelfService/en_US/plans.html).
MEDICAID SERVICES
HOW TO
CONTACT
SERVICE ACCESS ELIGIBILITY COVERED SERVICES COMMENTS
PERSON
SERVICES
EarlySteps Office for Citizens Children ages birth to three who Covered Services (Medicaid Covered) All services are provided through a plan of care Brenda Sharp
(Infant & Toddler Early with Developmental have a developmental delay of at -Family Support Coordination (Service called the Individualized Family Service Plan. 225/342-8853
Intervention Services) Disabilities least 1.5 SD (standard deviations) Coordination) Early Intervention is provided through
below the mean in two areas of -Occupational Therapy EarlySteps in conformance with Part C of the
1-866-783-5553 development listed below: -Physical Therapy Individuals with Disabilities Education Act.
or a. cognitive development -Speech/Language Therapy (IDEA).
1-866-earlystep b. physical development -Psychology
For families (vision & hearing) -Audiology
c. -- communication EarlySteps also provides the following
development services, not covered by Medicaid:
social or emotional -Nursing Services/Health Services (Only
development to enable an eligible child/family to
d. adaptive skills development benefit from the other EarlySteps
(also known as self-help or services).
daily living skills) -Medical Services for diagnostic and
1. Children with a diagnosed evaluation purposes only.
medical condition with a high -Special Instruction
probability of resulting in -Vision Services
developmental delay. -Assistive Technology devices and
services
-Social Work
-Counseling Services/Family Training
-Transportation
-Nutrition
-Sign language and cued language
services.
5
NOTE: The information listed in this document is applicable to Medicaid recipients in the fee-for-service Medicaid program. Bayou Health Plan members
should contact their plan’s member services with questions about how to access care (https://bayouhealth.com/LASelfService/en_US/plans.html).
MEDICAID SERVICES
HOW TO
CONTACT
SERVICE ACCESS ELIGIBILITY COVERED SERVICES COMMENTS
PERSON
SERVICES
EPSDT Behavioral Magellan Health Medicaid eligible youth who meets 1. Psychosocial EPSDT Behavioral Health services are Darrell
Health Services Services of the medical necessity criteria for Rehabilitation part of The Louisiana Behavioral Health Montgomery
Louisiana behavioral health services as 2. Crisis Intervention Partnership (LBHP) managed by DHH- 225/342-6255
1-800-424-4399 determined by a licensed mental 3. Community Psychiatric OBH (Office of Behavioral Health)
Visit online at health professional. Support & Treatment Mary Norris
www.Magellanof 4. Therapeutic Group Home 225/342-2768
Louisiana.com 5. Addiction Services
Meets medical necessity criteria for (outpatient and residential)
rehabilitation services for children 6. Outpatient & Inpatient
under the age of 21 restrictive level Hospital
of care 7. Psychiatric Residential
Treatment Facility (PRTF)
Addiction Services: 8. Outpatient Therapy
Any Medicaid-eligible person 9. Multi-systemic Therapy
needing medically necessary 10. Functional Family
substance abuse services Therapy
11. Homebuilders
Outpatient & Inpatient Hospital
and PRTF: Addiction Services
Medicaid eligible
Outpatient Therapy By Licensed Outpatient & Inpatient Hospital
Practitioners: Psychiatric Residential Treatment
Medicaid-eligible children who Facility
meet medical necessity criteria.
Outpatient Therapy By Licensed
Practitioners
Other Licensed Practitioner
Outpatient Therapy
Medical, Physician/Psychiatrist
Behavioral Health in FQHC
6
NOTE: The information listed in this document is applicable to Medicaid recipients in the fee-for-service Medicaid program. Bayou Health Plan members
should contact their plan’s member services with questions about how to access care (https://bayouhealth.com/LASelfService/en_US/plans.html).
MEDICAID SERVICES
HOW TO
CONTACT
SERVICE ACCESS ELIGIBILITY COVERED SERVICES COMMENTS
PERSON
SERVICES
Expanded Dental Medical The individual must be: Periodontal Exam; Radiographs (x- Recipients must obtain a referral from the
Services for Pregnant professional 1. Medicaid eligible for full rays); Prophylaxis (cleaning); medical professional providing pregnancy Cordelia Clay
Women (EDSPW) providing benefits* certain restorative services when the care using the BHSF Form 9-M. The 225/342-7878
pregnancy care 2. Age 21 through 59 location of the cavity to be restored recipient must provide the original
and Dentist. (See 3. Pregnant and provide to the is in an area that impacts the gum completed form to a participating dentist
Comments dentist an original or physician tissue and affects the periodontal prior to receiving any dental services
Section) faxed BHSF Form 9-M completed health of the woman; certain covered by Medicaid. Physician faxed
by the medical professional periodontal services; and certain oral forms are also acceptable. Participating
providing pregnancy care. and maxillofacial surgery services. medical professionals and dental providers
(Specific policy guidelines apply.) should have blank copies of the referral
Eligibility for the EDSPW form; however, the printable form is
Program ends at the conclusion located online at the following website:
of the pregnancy. The recipient www.lamedicaid.com
must be pregnant on each date of
service to be eligible for EDSPW
Program services. Some EDSPW Program services must be
Prior Authorized by Medicaid. The
*(Medicaid eligibles, age 21 and dental provider is responsible for
over, certified as Qualified submitting the prior authorization request
Medicare Beneficiary (QMB) only, for these services to Medicaid on behalf of
Medically Needy Program or other the patient. A prior authorization approval
programs with limited benefits are does not guarantee patient eligibility.
not eligible for dental services.)
7
NOTE: The information listed in this document is applicable to Medicaid recipients in the fee-for-service Medicaid program. Bayou Health Plan members
should contact their plan’s member services with questions about how to access care (https://bayouhealth.com/LASelfService/en_US/plans.html).
MEDICAID SERVICES
HOW TO
CONTACT
SERVICE ACCESS ELIGIBILITY COVERED SERVICES COMMENTS
PERSON
SERVICES
EPSDT Dental Dentist Medicaid recipients 0 to 21 years Bi-annual dental screening Some EPSDT Dental Program services
Services of age. consisting of an examination, must be Prior Authorized by Medicaid. Cordelia Clay
radiographs (x-rays) as appropriate, The dental provider will submit the request 225/342-7878
Presumptive Eligible (Type case prophylaxis (cleaning), topical for Prior Authorization of these services to
12) recipients are not eligible for fluoride application and oral hygiene Medicaid on behalf of the patient. A prior
dental care services. instruction. authorization approval does not guarantee
patient eligibility
The EPSDT Dental Program
provides coverage of certain
diagnostic; preventive; restorative;
endodontic; periodontic; removable
prosthodontic; maxillofacial
prosthetic; oral and maxillofacial
surgery; orthodontic; and adjunctive
general services. Specific policy
guidelines apply.
Comprehensive Orthodontic
Treatment (braces) require Prior
Authorization and are paid only
when there is a cranio-facial
deformity, such as cleft palate, cleft
lip, or other medical conditions
which possibly results in a
handicapping malocclusion. If such
a condition exists, the recipient
should see a Medicaid-enrolled
orthodontist. Patients having only
crowded or crooked teeth, spacing
problems or under/overbite are not
covered for braces, unless identified
as medically necessary.
8
NOTE: The information listed in this document is applicable to Medicaid recipients in the fee-for-service Medicaid program. Bayou Health Plan members
should contact their plan’s member services with questions about how to access care (https://bayouhealth.com/LASelfService/en_US/plans.html).
MEDICAID SERVICES
HOW TO
CONTACT
SERVICE ACCESS ELIGIBILITY COVERED SERVICES COMMENTS
PERSON
SERVICES
EPSDT Personal Physician and All Medicaid recipients 0 to 21 not Basic personal care-toileting & The Personal Care Agency must submit the Rene Huff
Care Services Personal Care receiving Individual Family grooming activities. Prior Authorization request. 225/342-3935
Attendant Support waiver services. However,
Agencies once a recipient receiving Assistance with bladder and/or Recipients receiving Support Coordination Linda Smith
(See Long Term – Individual Family Support waiver bowel requirements or problems. (Case Management Services) must also have 225/342-6711
Personal Care services has exhausted those their PCS Prior Authorized by Molina.
Services (LT-PCS) for services they are then eligible for Assistance with eating and food
PCS is not subject to service limits. Units
Medicaid recipients EPSDT Personal Care Services. preparation.
approved will be based on medical necessity
ages 65 or older, or and the need for covered services.
age 21 or older with Recipients of Children’s Choice Performance of incidental household
disabilities) Waiver can receive both PCS and chores, only for the recipient. Recipients receiving Personal Care Services
Family Support Services on the must have a physician’s prescription and
same day; however, the services Accompanying, not transporting, meet medical criteria.
may not be rendered at the same recipient to medical appointments.
time. Does not include medical tasks.
Does NOT cover any medical tasks
such as medication administration, Provided by licensed providers enrolled in
tube feedings. Medicaid to provide Personal Care Attendant
services.
Eyeglass
Services - See Optical
Services
Family Planning Planned Female Medicaid recipients Doctor visits to assess the patient’s Medicaid will reimburse the family Cordelia Clay
Clinic Services Parenthood between the ages of 10 and 60. physical status and contraceptive planning clinic for routine family planning 225/342-7878
Locations practices; nurse visits; physician services for family planning purposes only
counseling regarding sterilization; and not treatment of other medical
Office of Public nutrition counseling; social services conditions. Referrals should be made for
Health-Family counseling regarding the other medical problems as indicated.
Planning Clinics medical/family planning needs of
the patient; contraceptives; and Family Planning Clinics do not provide
certain lab services. services to pregnant women.
9
NOTE: The information listed in this document is applicable to Medicaid recipients in the fee-for-service Medicaid program. Bayou Health Plan members
should contact their plan’s member services with questions about how to access care (https://bayouhealth.com/LASelfService/en_US/plans.html).
MEDICAID SERVICES
HOW TO
CONTACT
SERVICE ACCESS ELIGIBILITY COVERED SERVICES COMMENTS
PERSON
SERVICES
Family Planning
Waiver Services –
See Waiver Services
Family Planning
Services in
Physician’s Office –
See Physician/
Professional Services
Federally Qualified Nearest FQHC All Medicaid recipients. Professional medical services There are 3 components that may be Kimberly Cezar
Health Centers furnished by physicians, nurse provided: 1) Encounter visits; 2) EPSDT 225/342-7878
(FQHC) practitioners, physician assistants, Screening Services; and 3) EPDST Dental,
nurse midwives, clinical social Adult Denture Services, and Expanded
workers, clinical psychologists, and Dental services for Pregnant Women.
dentists. Immunizations are covered
for recipients under age 21.
Hearing Aids - See Durable Medical Medicaid recipients 0 through 20 Hearing Aids and any related All services must be Prior Authorized Sylvia Green
Durable Medical Equipment years of age. ancillary equipment such as and the DME provider will arrange for the 225/342-7878
Equipment Provider earpieces, batteries, etc. Repairs are request of Prior Authorization.
covered if the Hearing Aid was paid
for by Medicaid. Cynthia Bennett
225/342-7878
Hemodialysis Dialysis Centers All Medicaid recipients. Dialysis treatment (including routine Gaynell Denova
Services - See laboratory services); medically 225/342-7878
Hospital-Outpatient Hospitals necessary non-routine lab services;
Services and medically necessary injections.
10
NOTE: The information listed in this document is applicable to Medicaid recipients in the fee-for-service Medicaid program. Bayou Health Plan members
should contact their plan’s member services with questions about how to access care (https://bayouhealth.com/LASelfService/en_US/plans.html).
MEDICAID SERVICES
HOW TO
CONTACT
SERVICE ACCESS ELIGIBILITY COVERED SERVICES COMMENTS
PERSON
SERVICES
Home Health Physician All Medicaid recipients. Intermittent/part-time nursing Recipients receiving Home Health must Cynthia Bennett
services including skilled nurse have physician’s prescription and signed 225/342-7878
Medically Needy (Type Case 20 & visits. plan of care.
21) recipients are not eligible for Aide Visits
Aide Visits, Physical Therapy, Physical Therapy Services PT, OT, and Speech/Language Therapy
Occupational Therapy, Occupational Therapy require Prior Authorization.
Speech/Language Therapy. Speech/Language Therapy
Home Health - Physician Medicaid recipients 0 through 20 Multiple hours of skilled nurse Recipients receiving extended nursing Cynthia Bennett
Extended years of age. services. services must have a letter of medical 225/342-7878
necessity and physician’s prescription.
All medically necessary medical
tasks that are part of the plan of care Extended Skilled nursing services require
can be administered in the home. Prior Authorization.
Hospice Services Hospice All Medicaid recipients. Medicare allowable services. Deloris Young
Provider/ Hospice eligibility information: 225/342-1417
Physician 1-800-877-0666, Option 2
Hospital Claim Physician/ All Medicaid recipients. Inpatient and Outpatient Hospital All Questions Regarding Denied Claims Recipients should
Questions - Hospital Services, including Emergency and/or Bills for Inpatient and Outpatient first contact the
Inpatient and Medically Needy (Type Case 20 & Room Services Hospital Services, including Emergency provider, then may
Outpatient Services, 21) under age 22 are not eligible Room Services contact an MMIS
including Emergency for Inpatient Psychiatric Services. Staff Member at
Room Services 225/342-3855 if
the issue cannot be
resolved
Providers should
contact Provider
Relations at
1-800-473-2783
11
NOTE: The information listed in this document is applicable to Medicaid recipients in the fee-for-service Medicaid program. Bayou Health Plan members
should contact their plan’s member services with questions about how to access care (https://bayouhealth.com/LASelfService/en_US/plans.html).
MEDICAID SERVICES
HOW TO
CONTACT
SERVICE ACCESS ELIGIBILITY COVERED SERVICES COMMENTS
PERSON
SERVICES
Hospital - Physician/ All Medicaid recipients. Inpatient hospital care needed for Inpatient hospitalization requires Pre- Annette Passman
Inpatient Services Hospital the treatment of an illness or injury certification and Length of Stay 225/342-7878
Medically Needy (Type Case 20 & which can only be provided safely & assignment. Hospitals are aware of this
21) under age 22 are not eligible adequately in a hospital setting. and will submit the request to the Prior
for Inpatient Psychiatric Services. Certification Unit.
Includes those basic services that a
hospital is expected to provide.
Hospital - Physician/ All Medicaid recipients. Diagnostic & therapeutic outpatient Outpatient rehabilitation services require Gaynell Denova
Outpatient Services Hospital services, including outpatient Prior Authorization. Provider will 225/342-7878
surgery and rehabilitation services. submit request for Prior Authorization.
Therapeutic and diagnostic
radiology services.
Chemotherapy
Hemodialysis
Hospital - Emergency Physician/ All Medicaid recipients. Emergency Room services. Recipients 0 to 21 years - No service Gaynell Denova
Room Services Hospital limits. 225/342-7878
Recipients 21 and older - Limited to 3
emergency room visits per calendar year
(January 1 - December 31).
Immunizations
See FQHC; EPSDT
Screening Services;
Physician/Professional
Services; Rural Health
Clinics
12
NOTE: The information listed in this document is applicable to Medicaid recipients in the fee-for-service Medicaid program. Bayou Health Plan members
should contact their plan’s member services with questions about how to access care (https://bayouhealth.com/LASelfService/en_US/plans.html).
MEDICAID SERVICES
HOW TO
CONTACT
SERVICE ACCESS ELIGIBILITY COVERED SERVICES COMMENTS
PERSON
SERVICES
Physician All Medicaid recipients 0 through Medical Screenings (including Recipients receive their screening Kimberly Cezar
20 years of age. immunizations and certain lab servicesfrom the primary care provider 225/342-7878
Child Health services). (PCP) or someone designated by the PCP.
Screenings/Checkups) Specialty Care
Vision Screenings Resource Line
(EPSDT Screening (877) 455-9955
Services) Hearing Screenings
Dental Screenings
Periodic and Interperiodic
Screenings
Laboratory Tests and Physician All Medicaid recipients. Most diagnostic testing and Some Radiology Services require prior Annette Passman
Radiology Services radiological services ordered by the approval. This process is 225/342-7878
attending or consulting physician. accomplished thru a contractual
agreement with MedSolutions. All
Portable (mobile) x-rays are covered
only for recipients who are unable to requests for any radiology services
leave their place of residence requiring prior approval are initiated by
without special transportation or the ordering physician. Recipients may
assistance to obtain physician follow up with the ordering physician for
ordered x-rays. the status of any ordered radiology service.
13
NOTE: The information listed in this document is applicable to Medicaid recipients in the fee-for-service Medicaid program. Bayou Health Plan members
should contact their plan’s member services with questions about how to access care (https://bayouhealth.com/LASelfService/en_US/plans.html).
MEDICAID SERVICES
HOW TO
CONTACT
SERVICE ACCESS ELIGIBILITY COVERED SERVICES COMMENTS
PERSON
SERVICES
Long Term -Personal Office of Aging All Medicaid recipients age 65 or -Basic personal care-toileting & Recipients or the responsible Gina Rossi
Care Services and Adult older, or age 21 or older with grooming activities. representative must request the service. 225/219-0225
Services (OAAS) disabilities (meets Social Security -Assistance with bladder and/or This program is NOT a substitute for
(LT-PCS) Administration disability criteria), bowel requirements or problems. existing family and/or community
Contact: meet the medical standards for -Assistance with eating and food supports, but is designed to supplement
(See EPSDT Personal Louisiana admission to a nursing facility and preparation. available supports to maintain the recipient
Care Services for Options in Long additional targeting criteria, and be -Performance of incidental in the community.
Medicaid recipients Term Care able to participate in his/her care household chores, only for the Once approved for services, the selected
ages 0 to 21) (XEROX) and direct the services provided by recipient. PCS Agency must obtain Prior
1-877-456-1146 the worker independently or -Accompanying, not transporting, Authorization.
through a responsible recipient to medical appointments. Amount of services approved will be
representative. Applicant must -Grocery shopping, including based on assessment of assistance needed
require at least limited assistance personal hygiene items. to perform daily living.
with at least one Activity of Daily Provided by PCS agencies enrolled in
Living. Medicaid.
Medical Emergency All Medicaid recipients. Emergency ambulance service may Ronald W. Johnson
Transportation ambulance be reimbursed if circumstances exist 225/342-2604
(Emergency) providers that make the use of any conveyance
other than an ambulance medically Steffan Rutledge
inadvisable for transport of the 225/342-6227
patient.
14
NOTE: The information listed in this document is applicable to Medicaid recipients in the fee-for-service Medicaid program. Bayou Health Plan members
should contact their plan’s member services with questions about how to access care (https://bayouhealth.com/LASelfService/en_US/plans.html).
MEDICAID SERVICES
HOW TO
CONTACT
SERVICE ACCESS ELIGIBILITY COVERED SERVICES COMMENTS
PERSON
SERVICES
Medical Regional All Medicaid recipients except Transportation to and from medical Recipients should call dispatch offices 48 Ronald W. Johnson
Transportation Dispatch Offices some who have Medicaid and appointments. hours before the appointment. 225/342-2604
(Non-Emergency) Medicare.
Dispatch Office The medical provider the recipient is Transportation to out-of-state
Phone Numbers: being transported to, does not have appointments can be arranged but requires Steffan Rutledge
to be a Medicaid enrolled provider Prior Authorization. 225/342-6227
Alexandria but the services must be Medicaid
800-446-3490 covered services. The dispatch Same day transportation can be
office will make this determination. scheduled when absolutely necessary.
Baton Rouge
800-259-1944 Recipients under 17 years old must
be accompanied by an attendant.
Lafayette/
Lake Charles
800-864-6034
Monroe
800-259-1835
New Orleans
800-836-9587
Shreveport
800-259-7235
Midwife Services
(Certified Nurse
Midwife) - See
FQHC; Physician/
Professional Services;
Rural Health Clinics
15
NOTE: The information listed in this document is applicable to Medicaid recipients in the fee-for-service Medicaid program. Bayou Health Plan members
should contact their plan’s member services with questions about how to access care (https://bayouhealth.com/LASelfService/en_US/plans.html).
MEDICAID SERVICES
HOW TO
CONTACT
SERVICE ACCESS ELIGIBILITY COVERED SERVICES COMMENTS
PERSON
SERVICES
Nurse Practitioners/
Clinical Nurse
Specialists -
See FQHC; Physician/
Professional Services;
Rural Health Clinics
Office of Aging Medicaid recipients and persons Skilled Nursing or medical care and Mary Perino
Nursing Facility and Adult who would meet Medicaid Long related services; rehabilitation
Services (OAAS) Term Care financial eligibility needed due to injury, disability, or 225/219-1150
requirements and who meet illness; health-related care and
Contact: nursing facility level of care as services (above the level of room
Louisiana determined by OAAS. and board) not available in the
Options in Long community, needed regularly due to
Term Care a mental or physical; condition.
(XEROX)
1-877-456-1146
Occupational
Therapy Services See
EarlySteps; Home
Health; Hospital-
Outpatient Services;
Rehabilitation Clinic
Services; Therapy
Services
16
NOTE: The information listed in this document is applicable to Medicaid recipients in the fee-for-service Medicaid program. Bayou Health Plan members
should contact their plan’s member services with questions about how to access care (https://bayouhealth.com/LASelfService/en_US/plans.html).
MEDICAID SERVICES
HOW TO
CONTACT
SERVICE ACCESS ELIGIBILITY COVERED SERVICES COMMENTS
PERSON
SERVICES
Recipients 0 to 21 Recipients 0 to 21
Optical Services Optometrist, All Medicaid recipients.
Ophthalmologist or Examinations and treatment of eye Specialty eyewear and contact lenses, if Sylvia Green
Optical Supplier conditions, including examinations for medically necessary for EPSDT eligibles 225/342-7878
vision correction, refraction error. requires Prior Authorization. The provider
will submit requests for the Prior
Cynthia Bennett
Regular eyeglasses when they meet a Authorization. A prior authorization approval
certain minimum strength requirement. does not guarantee patient eligibility. 225/342-7878
Medically necessary specialty eyewear
and contact lenses with prior Prescriptions are required for all Stephanie Young
authorization. Contact lenses are glasses/contacts. After a prescription is 225/342-7878
covered if they are the only means for obtained, the recipient may see an optical (Optical services
restoring vision. supplier to receive the glasses/contacts. other than
eyeglasses/
Other related services, if medically
eyewear)
necessary.
_____________________________ __________________________________
Recipients 21 and over Recipients 21 and over
Examinations and treatment of eye NON-COVERED SERVICES:
conditions, such as infections, cataracts, - routine eye examinations for vision correction
etc. - routine eye examinations for refraction error
- eyeglasses
If the recipient has both Medicare and
Medicaid, some vision related services
may be covered. The recipient should
contact Medicare for more information
since Medicare would be the primary
payer.
Orthodontic Services
- See Dental Care
Services
17
NOTE: The information listed in this document is applicable to Medicaid recipients in the fee-for-service Medicaid program. Bayou Health Plan members
should contact their plan’s member services with questions about how to access care (https://bayouhealth.com/LASelfService/en_US/plans.html).
MEDICAID SERVICES
HOW TO
CONTACT
SERVICE ACCESS ELIGIBILITY COVERED SERVICES COMMENTS
PERSON
SERVICES
Pediatric Day Health Physician or Medicaid recipient 0 to 21 who Nursing care, Respiratory care, The PDHC facility must submit the Prior Cynthia Bennett
Care (PDHC) PDHC Agencies have a medically fragile condition Physical Therapy, Speech-language Authorization request. 225/342-7878
and who require nursing therapy, occupational, personal care
services and transportation to and In order to receive PDHC, the recipient
supervision and possibly
from PDHC facility must have a prescription from their
therapeutic interventions all or part
of the day due to a medically prescribing physician and meet the
complex condition. medical criteria.
PDHC may be provided up to seven days
per week and up to 12 hours per day for
Medicaid recipients as documented by the
recipient’s Plan of Care.
Services are provided by licensed
providers enrolled in Medicaid to provide
PDHC services.
The following services are not covered–
before and after school care; medical
equipment, supplies and appliances;
parenteral or enteral nutrition; infant food
or formula.
Prescribed medications are to be provided
each day by recipient’s parent/guardian.
18
NOTE: The information listed in this document is applicable to Medicaid recipients in the fee-for-service Medicaid program. Bayou Health Plan members
should contact their plan’s member services with questions about how to access care (https://bayouhealth.com/LASelfService/en_US/plans.html).
MEDICAID SERVICES
HOW TO
CONTACT
SERVICE ACCESS ELIGIBILITY COVERED SERVICES COMMENTS
PERSON
SERVICES
Program of All- Office of Aging Participants are persons age 55 ALL Medicaid and Medicare - Emphasis is on enabling participants to Allison Vuljoin
Inclusive Care for and Adult years or older, live in the PACE services, both acute and long-term remain in community and enhance 225/219-0229
the Elderly (PACE)* Services (OAAS) provider service area, are certified care quality of life.
to meet nursing facility level of
Contact: care and financially eligible for - Interdisciplinary team performs
*Program available in PACE GNO at Medicaid long term care. assessment and develops individualized
New Orleans and in (504)945-1531 Participation is voluntary and plan of care.
Baton Rouge area. enrollees may disenroll at any time.
- Each PACE program serves a specific
Franciscan geographic region.
PACE
Baton Rouge: - PACE programs bear financial risk for
(225)490-0640 all medical support services required
for enrollees.
- PACE programs receive a monthly
capitated payment for Medicaid and
Medicare eligible enrollees.
19
NOTE: The information listed in this document is applicable to Medicaid recipients in the fee-for-service Medicaid program. Bayou Health Plan members
should contact their plan’s member services with questions about how to access care (https://bayouhealth.com/LASelfService/en_US/plans.html).
MEDICAID SERVICES
HOW TO
CONTACT
SERVICE ACCESS ELIGIBILITY COVERED SERVICES COMMENTS
PERSON
SERVICES
Pharmacy Services Pharmacies All Medicaid recipients except Covers prescription drugs except: Co-payments ($0.50-$3.00) are required Amanda Caire
some who are Medicare/Medicaid Cosmetic drugs (Except except for some recipient categories. 225/342-7878
eligible. Accutane);
Cough & cold preparations; NO co-payments for recipients under age
Recipients who are full benefit Anorexics (Except for Xenical); 21, pregnant women, or those in Long For general
dual eligible (Medicare/Medicaid) Fertility drugs when used for Term Care. pharmacy
received their pharmacy benefits fertility questions:
through Medicare Part D. treatment; Prescription limits: 4 per month (The
Experimental drugs; physician can override this limit when 1-800-437-9101
Compounded prescriptions; medically necessary.) Limits do not apply
Vaccines covered in other to recipients under age 21, pregnant
programs; women, or those in Long Term Care.
Drug Efficacy Study
Implementation Prior Authorization is required for some
(DESI) drugs; drug categories if the medication is not on
Over the counter (OTC) drugs the Preferred Drug List (PDL). Children
with are not exempt from this process. The
some exceptions; PDL can be accessed at
Narcotics prescribed only for www.lamedicaid.com.
narcotic addiction
Physical Therapy -
See EarlySteps; Home
Health; Hospital-
Outpatient Services;
Rehabilitation Clinic
Services; Therapy
Services
Physician Assistants -
See FQHC; Physician/
Professional Services;
Rural Health Clinics
20
NOTE: The information listed in this document is applicable to Medicaid recipients in the fee-for-service Medicaid program. Bayou Health Plan members
should contact their plan’s member services with questions about how to access care (https://bayouhealth.com/LASelfService/en_US/plans.html).
MEDICAID SERVICES
HOW TO
CONTACT
SERVICE ACCESS ELIGIBILITY COVERED SERVICES COMMENTS
PERSON
SERVICES
Physician/ Physician or All Medicaid recipients. Professional medical services Some services require Prior Stephanie Young
Professional Services Healthcare including those of a physician, nurse Authorization. Providers will submit 225/342-7878
Professional midwife, nurse practitioner, clinical requests for Prior Authorization.
nurse specialists, physician assistant,
audiologist. Services are subject to limitations and
exclusions. Your physician or healthcare
Immunizations are covered for professional can help you with this.
recipients under age 21.
Recipients 21and over are limited to 12
Certain family planning services outpatient visits per calendar year unless
when provided in a physician’s an extension is granted. Your physician or
office. healthcare professional must request an
extension if deemed necessary.
Recipients under 21 are not limited to the
number of outpatient visits.
Podiatry Services Podiatrist All Medicaid recipients. Office visits. Some Prior Authorization, exclusions, Stephanie Young
and restrictions apply. Providers will 225/342-7878
Certain radiology & lab procedures submit request for Prior Authorization.
and other diagnostic procedures.
Pre-Natal Care Physicians or Female Medicaid recipients of Office visits. Some limitations apply. Mary Wolf
Services Healthcare child bearing age. Other pre- & post-natal care and 225/342-7878
Professional delivery.
Lab and radiology services.
Psychiatric Hospital
Care Services - See
Hospital-Inpatient
Services
Rehabilitation Clinic Physician All Medicaid recipients Occupational Therapy All services must be Prior Authorized. Cynthia Bennett
Services Physical Therapy 225/342-7878
Speech, Language and Hearing The provider of services will submit the
Therapy request for Prior Authorization.
21
NOTE: The information listed in this document is applicable to Medicaid recipients in the fee-for-service Medicaid program. Bayou Health Plan members
should contact their plan’s member services with questions about how to access care (https://bayouhealth.com/LASelfService/en_US/plans.html).
MEDICAID SERVICES
HOW TO
CONTACT
SERVICE ACCESS ELIGIBILITY COVERED SERVICES COMMENTS
PERSON
SERVICES
Rural Health Clinics Rural Health All Medicaid recipients Professional medical services There are 3 components that may be Kimberly Cezar
Clinic furnished by physicians, nurse provided: 1) Encounter visits; 2) 225/342-7878
practitioners, physician assistants, KIDMED Screening Services; and 3)
nurse midwives, clinical social EPDST Dental, Adult Denture Services,
workers, clinical psychologists, and and Expanded Dental services for Pregnant
dentists. Immunizations are covered Women.
for recipients under age 21.
Sexually Transmitted Local Health Unit All Medicaid recipients. Testing, counseling, and treatment Stephanie Young
Disease Clinics (STD) of all sexually transmitted diseases 225/342-7878
(STD). Confidential HIV testing.
Speech and
Language Evaluation
and Therapy – See
EarlySteps; Home
Health; Hospital-
Outpatient Services;
Rehabilitation Clinic
Services; Therapy
Services
22
NOTE: The information listed in this document is applicable to Medicaid recipients in the fee-for-service Medicaid program. Bayou Health Plan members
should contact their plan’s member services with questions about how to access care (https://bayouhealth.com/LASelfService/en_US/plans.html).
MEDICAID SERVICES
HOW TO
CONTACT
SERVICE ACCESS ELIGIBILITY COVERED SERVICES COMMENTS
PERSON
SERVICES
Support Office for Medicaid recipients must be in Coordination of Medicaid and other Services must be prior authorized by Teresa Frank
Coordination Citizens with the Children’s Choice Waiver. services. The Support Coordinator DHH, Office for Citizens with 225/342-8762
Services (Case Developmental (Case Manager) helps to identify Developmental Disabilities, Waiver
Management) - Disabilities, There is a Request for Services needs, access services and Supports and Services. The support
Children’s Choice Waiver Supports Registry (RFSR) for those coordinate care. coordinator will submit requests for the
Waiver and Services requesting waiver services. To get Services available through the Prior Authorization.
(1-866-783-5553) on the Request for Services Waiver are identified in the waiver
Registry, call the Office for section of this document.
Citizens with Developmental
Disabilities
District/Authority/Local Regional
Office contact information is
located at:
http://new.dhh.louisiana.gov/index.
cfm/page/134/n/137
Applicants/
Support Office of Aging Medicaid recipients must be in Coordination of Medicaid and other Services must be prior authorized by Participants call
Coordination and Adult the Community Choices Waiver services. The Support Coordinator DHH, Office of Aging and Adult Services 1-866-758-5035
Services (Case Services (OAAS) (CCW). (Case Manager) helps to identify (OAAS). The provider will submit
Management) - (1-866-758-5035) needs, access services and requests for the Prior Authorization. Providers call
Community Choices There is a Request for Services coordinate care. Rhonda
Waiver Registry (RFSR) for those Habisretinger
requesting CCW Waiver 225/342-1981
services. Contact Louisiana
Options in Long Term Care at 1-
877-456-1146.
23
NOTE: The information listed in this document is applicable to Medicaid recipients in the fee-for-service Medicaid program. Bayou Health Plan members
should contact their plan’s member services with questions about how to access care (https://bayouhealth.com/LASelfService/en_US/plans.html).
MEDICAID SERVICES
HOW TO
CONTACT
SERVICE ACCESS ELIGIBILITY COVERED SERVICES COMMENTS
PERSON
SERVICES
Support SRI Must be Medicaid eligible and on Coordination of Medicaid and other Support Coordination Services must be Tara DiSandro
Coordination (1-800-364-7828) the DD Request for Services services. The Support Coordinator prior authorized by DHH, BHSF, and 225/342-9201
Services (Case Registry prior to receipt of case (Case Manager) helps to identify Waiver Compliance Section. The Support
Management) - Must be on the management services; or any needs, access services and Coordination Agency will submit requests
EPSDT Targeted DD Request for Medicaid recipient 3 through 20 coordinate care. for the Prior Authorization to SRI. For
Populations Services Registry years of age for whom support other EPSDT services, see that portion of
coordination is medically the chart.
necessary (Call SRI at 1-800-364-
7828).
To get on the Request for Services
Registry, call the Office for
Citizens with Developmental
Disabilities
District/Authority/Local Regional
Office
Support Office of Public Medicaid recipient must have HIV Coordination of Medicaid and other Services must be prior authorized by Applicants/
Coordination Health-HIV/Aids as determined by a physician. services. The Support Coordinator DHH, Office of Public Health (OPH) Participants call
Services (Case and HIV Support (Case Manager) helps to identify STD/HIV Program. The provider will 504/568-7474
Management) - HIV Coordination needs, access services and submit requests for the Prior
Agencies coordinate care. Authorization. Providers call the
Case Management
Office of Public Housing
Health Coordinator at
(504)568-7474 504/568-5448
24
NOTE: The information listed in this document is applicable to Medicaid recipients in the fee-for-service Medicaid program. Bayou Health Plan members
should contact their plan’s member services with questions about how to access care (https://bayouhealth.com/LASelfService/en_US/plans.html).
MEDICAID SERVICES
HOW TO
CONTACT
SERVICE ACCESS ELIGIBILITY COVERED SERVICES COMMENTS
PERSON
SERVICES
Support Office for Medicaid recipients must be 0 to 3 Coordination of Medicaid and other Services must be authorized by Brenda Sharp
Coordination Citizens with years of age and have a services. The Support Coordinator EarlySteps. Authorizations are approved 225/342-8853
Services (Case Developmental developmental delay or an (Case Manager) helps to identify through the Individualized Family Service
Management) - Disabilities established medical condition and needs, access services and Plan (IFSP) process.
Infants and Toddlers (OCDD) eligible for the EarlySteps system coordinate care in EarlySteps.
contact information is located at:
1-866-783-5553 http://new.dhh.louisiana.gov/index.
cfm/page/134/n/137
Support Office for Medicaid recipients must be Coordination of Medicaid and other Services must be prior authorized by Teresa Frank
Coordination Citizens with receiving the NOW. services. The Support Coordinator DHH, Office for Citizens with 225/342-8762
Services (Case Developmental (Case Manager) helps to identify Developmental Disabilities, Waiver
Management) - New Disabilities, There is a Request for Services needs, access services and Supports and Services. The support
Opportunities Waiver Supports Registry (RFSR) for those coordinate care. coordinator will submit requests for the
Waiver (NOW) and Services requesting waiver services. To get Services available through the Prior Authorization.
(1-866-783-5553) on the Request for Services Waiver are identified in the waiver
Registry, call the Office for section of this document.
Citizens with Developmental
Complaints Line: Disabilities
(1-800-660-0488) District/Authority/Local Regional
Office contact information is
located at:
http://new.dhh.louisiana.gov/index.
cfm/page/134/n/137
25
NOTE: The information listed in this document is applicable to Medicaid recipients in the fee-for-service Medicaid program. Bayou Health Plan members
should contact their plan’s member services with questions about how to access care (https://bayouhealth.com/LASelfService/en_US/plans.html).
MEDICAID SERVICES
HOW TO
CONTACT
SERVICE ACCESS ELIGIBILITY COVERED SERVICES COMMENTS
PERSON
SERVICES
Support Office for Medicaid recipients must be in Coordination of Medicaid and other Services must be prior authorized by Teresa Frank
Coordination Citizens with the Supports Waiver. services. The Support Coordination DHH, Office for Citizens with 225/342-8762
Services (Case Developmental (Case Manager) helps to identify Developmental Disabilities, Waiver
Management) – Disabilities, There is a Request for Services needs, access services and Supports and Services. The support
Supports Waiver Waiver Supports Registry (RFSR) for those coordinate care. Some services coordinator will submit requests for the
and Services requesting this waiver. To get on available through this waiver are Prior Authorization.
(1-866-783-5553) the Request for Services Registry, identified in the waiver section
call the Office for Citizens with
Developmental Disabilities
Complaints Line: District/Authority/Local Regional
(1-800-660-0488) Office contact information is
located at:
http://new.dhh.louisiana.gov/index.
cfm/page/134/n/137
Therapy Services Recipients have Medicaid recipients birth through Audiological Services (Available Covered services can be provided in the Kimberly Cezar
the choice of 20 years of age. in Rehabilitation Clinic and home through Home Health and 225/342-6253
services from the Hospital-Outpatient settings Rehabilitation Clinics. Services provided
following only.) by Rehabilitation Clinics can also be NOTE:
provider types: Occupational Therapy provided at the clinic. Services provided
Home Health; Physical Therapy through Hospital-Outpatient Services must For details on
Hospital- Speech & Language Therapy be provided at the facility/clinic. Covered services provided
Outpatient services may be provided in addition to in Home Health,
Services; services provided by EarlySteps/EICs or Rehabilitation
Rehabilitation School Boards if prescribed by a physician Clinic, or Hospital-
Clinic Services and Prior Authorized.
Outpatient settings
All medically necessary services must be , please refer to
prescribed by a physician and Prior those sections of
Authorization is required. The provider this Medicaid
of services will submit requests for Prior Services Chart.
Authorization.
26
NOTE: The information listed in this document is applicable to Medicaid recipients in the fee-for-service Medicaid program. Bayou Health Plan members
should contact their plan’s member services with questions about how to access care (https://bayouhealth.com/LASelfService/en_US/plans.html).
MEDICAID SERVICES
HOW TO
CONTACT
SERVICE ACCESS ELIGIBILITY COVERED SERVICES COMMENTS
PERSON
SERVICES
Therapy Services EPSDT Health Medicaid recipients under 3 years Audiological Services All EPSDT Health Services through EICs Kimberly Cezar
continued Services-Early of age. Occupational Therapy and EarlySteps must be included in the 225/342-7878
Intervention Physical Therapy infant/toddler’s Individualized Family
Centers (EIC) or Speech & Language Therapy Services Plan (IFSP).
EarlySteps Psychological Therapy If services are provided by an EIC or
Program EarlySteps, Prior Authorization
requirements are met through inclusion of
services on the IFSP.
Therapy Services EPSDT Health Medicaid recipients 3 through 20 Audiological Evaluation and Services are performed by the Local Anissa Young
continued Services- Local years of age. Therapy Education Agencies (LEA) 225/342-2173
Education Occupational Therapy Evaluation All EPSDT Health Services must be
Agencies (LEA) and Treatment services included in the child’s Individualized
e.g. School Physical Therapy Evaluation and Education Program (IEP).
Boards Treatment services If services are provided by a, LEA Prior
Speech & Language Evaluation Authorization requirements are met
and Therapy through inclusion of services on the IEP.
Psychological Evaluation
including a battery of tests,
interviews, and behavioral
evaluations that appraise
cognitive, emotional, social, and
behavioral functioning and self-
concept.
Psychological Therapy includes
diagnosis and psychological
counseling for children and their
parents.
Transportation
See Medical
Transportation
Tuberculosis Clinics Local Health Unit All Medicaid recipients Treatment and disease management Stephanie Young
services including physician visits, 225/342-7878
medications and x-rays.
27
NOTE: The information listed in this document is applicable to Medicaid recipients in the fee-for-service Medicaid program. Bayou Health Plan members
should contact their plan’s member services with questions about how to access care (https://bayouhealth.com/LASelfService/en_US/plans.html).
MEDICAID SERVICES
HOW TO
CONTACT
SERVICE ACCESS ELIGIBILITY COVERED SERVICES COMMENTS
PERSON
SERVICES
X-Ray Services - See
Laboratory Tests and
X-Ray Services
There is a Request for Services
WAIVER Registry (RFSR) for those See Specific
SERVICES: requesting any of the waiver Waiver
services below.
Adult Day Health Office of Aging Individuals 65 years of age or - Adult Day Health Care services This is a home and community - based Applicants/
Care (ADHC) and Adult older, who meet Medicaid financial - Transition Services alternative to nursing facility placement. Participants call
Services (OAAS) eligibility, imminent risk criteria - Support Coordination 1-866-758-5035
and meet the criteria for admission - Transition Intensive Support
Contact: to a nursing facility; or age 22-64 Coordination Providers call
Louisiana who are disabled according to Rhonda
Options in Long Medicaid standards or SSI Habisretinger
Term Care disability criteria, meet Medicaid 225/342-1981
(1-877-456-1146) financial eligibility and meet the
criteria for admission to a nursing
facility
28
NOTE: The information listed in this document is applicable to Medicaid recipients in the fee-for-service Medicaid program. Bayou Health Plan members
should contact their plan’s member services with questions about how to access care (https://bayouhealth.com/LASelfService/en_US/plans.html).
MEDICAID SERVICES
HOW TO
CONTACT
SERVICE ACCESS ELIGIBILITY COVERED SERVICES COMMENTS
PERSON
SERVICES
Children’s Choice Office for Child must be on the DD Request - Center Based Respite There is a $16,410 limit per individual T. Denise Boyd
Citizens with for Services Registry, less than 19 plan year. ($1500 for Case Management 225/342-9261 or
-Environmental Accessibility
Developmental years old, disabled according to balance for other services). 225/342-0095
Disabilities SSI criteria, require ICF/DD level Adaptation
Districts/ of care, have income less than 3 * Call the Office for Citizens with
-Family Training
Authorities/Local times SSI amount, resources less Developmental Disabilities
Regional Offices than $2,000 and meet all Medicaid -Family Support Districts/Authorities/Local Regional
(SYSTEM non-financial requirements.
-Crisis Support Offices for status on the Request for
ENTRY) contact
information is -Non-Crisis Support Services Registry. (See Appendix for
located at: telephone numbers)
-Support Coordination
http://new.dhh.lo
uisiana.gov/index
.cfm/page/134/n/1 Complaints Line:
37 1-800-660-0488
Community Choices Office of Aging Individuals 65 years of age or - Support Coordination This is a home and community-based Applicants/
Waiver (CCW) and Adult older, who meet Medicaid financial - Environmental Accessibility alternative to nursing facility placement. Participants call
Services (OAAS) eligibility and meet the criteria for Adaptation 1-866-758-5035
admission to a nursing facility; or -Transition Intensive Support
Contact: age 21-64 who are disabled Coordination Providers call
Louisiana according to Medicaid standards or -Transition Service Rhonda
Options in Long SSI disability criteria, meet - Personal Assistance Services Habisretinger
Term Care Medicaid financial eligibility, and - Adult Day health Care Services 225/342-1981
(1-877-456- meet the criteria for admission to a - Assistive Devices and Medical -
1146) nursing facility Supplies
- Skilled Maintenance Therapy
Services
- Nursing Services
- Home Delivered Meal Services
- Caregiver Temporary Support
Services
29
NOTE: The information listed in this document is applicable to Medicaid recipients in the fee-for-service Medicaid program. Bayou Health Plan members
should contact their plan’s member services with questions about how to access care (https://bayouhealth.com/LASelfService/en_US/plans.html).
MEDICAID SERVICES
HOW TO
CONTACT
SERVICE ACCESS ELIGIBILITY COVERED SERVICES COMMENTS
PERSON
SERVICES
Regina Williams
Family Planning Any Medicaid Women ages 19-44 who are Covered services include a yearly This is a wavier program with benefits
225/342-2612
Waiver- provider who Louisiana residents, with an physical exam, pap smear, being limited to family planning services.
TAKE CHARGE offers family income below 200% of the Federal laboratory tests, contraceptive There are no enrollment fees, no
planning services. Poverty level, without health counseling, medications, and premiums, co-payments or deductibles.
insurance that offers family supplies (such as birth control pills, Mammograms and Hysterectomies are not
For assistance planning services. patches, injections, IUDs and a covered service. American Indian “638”
with locating a diaphragms), and voluntary Clinics, RHCs and FQHCs are reimbursed
provider call sterilization. at fee-for-service rates.
1-877-455-9955
New Opportunities Office for Individuals three(3) years of age or An array of services to provide *Call the Office for Citizens with Anita Lewis
Waiver (NOW) Citizens with older, who have a developmental support to maintain persons in the Developmental Disabilities 225/342-4464 or
Developmental disability which manifested prior to community: Districts/Authorities/Local Regional 225/342-0095
Disabilities the age of 22, and who meet both
Offices for status on the Request for
Districts/Authorit SSI Disability criteria and the level Individual Family Support, Day and
ies/Local of care determination for an Night; Shared Supports; Center Services Registry. (See Appendix for
Regional Offices ICF/DD. Based Respite Care; Community telephone numbers)
SYSTEM ENTRY Integration Development;
contact Environmental Accessibility
information is Adaptations, Specialized Medical
located at: Equipment and Supplies; Substitute Complaints Line:
http://new.dhh.lo Family Care Services; Supported 1-800-660-0488
uisiana.gov/index Living; Day Habilitation; Supported
.cfm/page/134/n/1 Employment; Employment-Related
37 Training; Professional Services; One
Time Transitional Expense; Skilled
Nursing; and Personal Emergency
Response System.
30
NOTE: The information listed in this document is applicable to Medicaid recipients in the fee-for-service Medicaid program. Bayou Health Plan members
should contact their plan’s member services with questions about how to access care (https://bayouhealth.com/LASelfService/en_US/plans.html).
MEDICAID SERVICES
HOW TO
CONTACT
SERVICE ACCESS ELIGIBILITY COVERED SERVICES COMMENTS
PERSON
SERVICES
Residential Options Office for
Waiver (ROW) Citizens with Individuals, birth to end of life, Covered services include: Support Becky Palmer
Developmental who have a developmental Coordination, Community Living 225/342-6748
Complaints Line: 1-800-660-0488
Disabilities disability which manifested prior to Supports, Host Home Services,
Districts/Authorit the age of 22. Companion Care Services, Shared
ies/Local (Must meet the Louisiana Living, Respite Care-Out of Home,
Regional offices. definition of DD). Personal Emergency Response
System Entry System, One Time Transition
contact Services, Environmental
information is Accessibility Adaptations, Assistive
located at: Technology/Specialized Medical
http://new.dhh.lo Equipment and Supplies,
uisiana.gov/index Transportation-Community Access,
.cfm/page/134/n/1 Professional Services, Nursing
37 Services, Dental Services,
Supported Employment,
Prevocational Services, and Day
Habilitation.
Supports Waiver Office for Individuals age 18 and older who Covered services include: Support Rosemary Morales
Citizens with have been diagnosed with a Coordination, Supported Complaints Line: 1-800-660-0488 225/342-8901
Developmental Developmental Disability which Employment, Day Habilitation, Pre-
Disabilities manifested prior to age 22. (Must Vocational, Habilitation, Respite,
Districts/Authorit meet the Louisiana definition of and Personal Emergency Response
ies/Local DD). System
Regional Offices
System Entry
contact
information is
located at:
http://new.dhh.lo
uisiana.gov/index
.cfm/page/134/n/1
37
* Exclusion from this list does not necessarily mean that a service is not covered. Please call one of the appropriate contacts for
questions regarding coverage of services not listed on this chart.
31
