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					         LOUISIANA DEPARTMENT OF HEALTH & HOSPITALS




    MEDICAID SERVICES CHART
                   November 2008
                              
                              
 

 

 




 
 

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    Wendy McGraw
Services                                    and older.                            denture repairs.                     Prior Authorization. The provider will     225/342-4423
                                                                                                                       submit requests for the Prior
                                            (Adults, 21 and over, certified as    Examination and X-rays are covered   Authorization.                             Cordelia Clay
                                            Qualified Medicare Beneficiary        if in conjunction with the                                                      225/342-4182
                                            (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 a seven-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 KIDMED
Audiological
Services –See
EarlySteps;
KIDMED-EPSDT
Services; Hospital-
Outpatient services;
Physician/
Professional
Services;
Rehabilitation
Clinic Services;
Therapy Services
Chemotherapy
Services-See           Hospital
                                                                                  Chemotherapy administration and
Hospital-Outpatient
                                            All Medicaid Recipients.              treatment drugs, as prescribed by
Services; Physician/   Physician’s office
                                                                                  physician.
Professional           or clinic
Services



                                                                                            2 
 
MEDICAID SERVICES
                       HOW TO
                                                                                                                                                                   CONTACT
SERVICE                ACCESS           ELIGIBILITY                        COVERED SERVICES                       COMMENTS
                                                                                                                                                                   PERSON
                       SERVICES


Chiropractic           KIDMED           Medicaid recipients 0 through 20   Spinal manipulations.                  Medically necessary manual                       Brian Bagdan
Services               Medical          years of age.                                                             manipulations of the spine when the              225/342-1461
                       Screening                                                                                  service is provided as a result of a referral
                       Provider/PCP                                                                               from a KIDMED medical screening
                                                                                                                  provider or Primary Care Provider (PCP).

CommunityCARE          Recipient Toll   Most Medicaid eligibles are        CommunityCARE enrollees are            CommunityCARE is a Medicaid program              Veronica Dent
                       Free:            required to participate in         entitled to the same Medicaid          designed to provide Medicaid recipients          225/342-0327
                       1-800-259-4444   CommunityCARE. For exceptions      covered services as those eligibles    with a medical home. Each enrollee is
                                        to this requirement, contact the   not in CommunityCARE.                  linked to a PCP who is responsible for
                                        CommunityCARE Program.                                                    coordinating primary health care services,
                                                                           Most Medicaid covered services         either through direct service or appropriate
                                                                           must be provided by the PCP or         referral authorization to a specialist and /or
                                                                           must be authorized by the PCP          ancillary providers.
                                                                           prior to the service being rendered.

                                                                           Services provided in the emergency
                                                                           room, equivalent to the two low
                                                                           level CPT codes, must be post-
                                                                           authorized by the PCP in order for
                                                                           the service to be deemed “covered.”
Dental Care
Services - See Adult
Denture Services;
EPSDT Dental
Services; and
Expanded Dental
Services for
Pregnant Women




                                                                                     3 
 
MEDICAID SERVICES
                     HOW TO
                                                                                                                                                                                 CONTACT
SERVICE              ACCESS               ELIGIBILITY                               COVERED SERVICES                          COMMENTS
                                                                                                                                                                                 PERSON
                     SERVICES


Durable Medical      Physician            All Medicaid recipients.                  Medical equipment and appliances such     All services must be prescribed by a               Stephanie Young
Equipment (DME)                                                                     as wheelchairs, leg braces, etc.          physician and must be Prior Authorized.            225/342-3935
                                                                                    Medical supplies such as ostomy
                                                                                                                              DME providers will arrange for the Prior           Sylvia Green
                                                                                    supplies, etc.
                                                                                                                              Authorization request.                             225/342-1247
                                                                                    Diapers and blue pads are not
                                                                                    reimbursable as durable medical
                                                                                    equipment items. EPSDT
                                                                                                                                                                                 Rhonda
                                                                                    RECIPIENTS ARE EXCLUDED                                                                      Habisreitinger
                                                                                    FROM THIS LIMITATION.                                                                        225/342-4839



EarlySteps           Office of Citizens   1.   Children ages birth to three who     Covered Services (Medicaid Covered)       All services are provided through a plan of care   Brenda Sharp
(Infant & Toddler    with Developmental        have a developmental delay of at     -Family Support Coordination (Service     called the Individualized Family Service Plan.     225/342-8853
Early Intervention   Disabilities              least 1.5 SD (standard deviations)   Coordination)                             Early Intervention is provided through
Services)                                      below the mean in one area of        -Occupational Therapy                     EarlySteps in conformance with Part C of the
                     1-866-783-5553            development listed below or in       -Physical Therapy                         Individuals with Disabilities Act.
                     or                        one sub-area in communication or     -Speech/Language Therapy
                     1-866-earlystep           physical development:                -Psychology
                      For families             a.    cognitive development          -Audiology
                                               b.    physical development           EarlySteps also provides the following
                                                     (vision & hearing)             services, not covered by Medicaid:
                                                     --fine motor                   -Nursing Services/Health Services (Only
                                                     --gross motor                  to enable an eligible child/family to
                                               c.     communication                 benefit from the other EarlySteps
                                                     development                    services).
                                                     --receptive language           -Medical Services for diagnostic and
                                                     --expressive language          evaluation purposes only.
                                               d.    social or emotional            -Special Instruction
                                                     development                    -Vision Services
                                               e.    adaptive skills development    -Assistive Technology devices and
                                                     (also known as self-help or    services
                                                     daily living skills)           -Social Work
                                          2.   Children with a diagnosed            -Counseling Services/Family Training
                                               medical condition with a high        -Transportation
                                               probability of resulting in          -Nutrition
                                               developmental delay.                 -Sign language and cued language
                                                                                    services.




                                                                                              4 
 
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    Wendy McGraw
Services for      professional        1. Medicaid eligible for full        rays); Prophylaxis (cleaning);           medical professional providing pregnancy      225/342-4423
Pregnant Women    providing           benefits*                            certain restorative services when the    care using the BHSF Form 9-M. The
(EDSPW)           pregnancy care      2. Age 21 through 59                 location of the cavity to be restored    recipient must provide the original           Cordelia Clay
                  and Dentist. (See   3. Pregnant and provide to the       is in an area that impacts the gum       completed form to a participating dentist     225/342-4182
                  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.)




                                                                                     5 
 
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             Wendy McGraw
Services                  of age.                               consisting of an examination,            must be Prior Authorized by Medicaid.          225/342-4423
                                                                radiographs (x-rays) as appropriate,     The dental provider will submit the request
                          Presumptive Eligible (Type case       prophylaxis (cleaning), topical          for Prior Authorization of these services to   Cordelia Clay
                          12) recipients are not eligible for   fluoride application and oral hygiene    Medicaid on behalf of the patient. A prior     225/342-4182
                          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.




                                                                          6 
 
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      Lynda Wascom
Care Services           Personal Care       receiving Individual Family           grooming activities.                   Prior Authorization request.                  225/342-9485
                        Attendant           Support waiver services. However,
                        Agencies            once a recipient receiving            Assistance with bladder and/or         Recipients receiving Support Coordination
(See Long Term –                            Individual Family Support waiver      bowel requirements or problems.        (Case Management Services) must also have
Personal Care                               services has exhausted those                                                 their PCS Prior Authorized by Unisys.
Services (LT-PCS)                           services they are then eligible for   Assistance with eating and food
                                                                                                                         PCS is not subject to service limits. Units
for Medicaid                                EPSDT Personal Care Services.         preparation.
                                                                                                                         approved will be based on medical necessity
recipients ages 65 or                                                                                                    and the need for covered services.
older, or age 21 or                         Recipients of Children’s Choice       Performance of incidental household
older with                                  Waiver can receive both PCS and       chores, only for the recipient.        Recipients receiving Personal Care Services
disabilities)                               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.

EPSDT                   PBS enrolled        Medicaid recipients, under the age    Psychological and Behavioral                                                         Wendy McGraw
Psychological and       Psychologist        of 21, who meet the criteria for      Services include necessary                                                           225/342-4423
Behavioral                                  Pervasive Developmental Disorder      assessments, evaluations, individual
Services (PBS)          (For a list of      (PDD), or other specific criteria.    therapy and family therapy.
                        providers in your
                        area, contact the
                        Specialty Care
                        Resource Line at
                        1-877-455-9955)

Eyeglass
Services - See
Optical Services




                                                                                            7 
 
MEDICAID SERVICES
                      HOW TO
                                                                                                                                                                   CONTACT
SERVICE               ACCESS             ELIGIBILITY                        COVERED SERVICES                         COMMENTS
                                                                                                                                                                   PERSON
                      SERVICES


Family Planning       Family Planning    Female Medicaid recipients         Doctor visits to assess the patient’s    Medicaid will reimburse the family            Wendy McGraw
Clinic Services       Clinics            between the ages of 10 and 60.     physical status and contraceptive        planning clinic for routine family planning   225/342-4423
                                                                            practices; nurse visits; physician       services for family planning purposes only
                      Office of Public                                      counseling regarding sterilization;      and not treatment of other medical            Cordelia Clay
                      Health-Family                                         nutrition counseling; social services    conditions. Referrals should be made for      225/342-4182
                      Planning Clinics                                      counseling regarding the                 other medical problems as indicated.
                                                                            medical/family planning needs of
                                                                            the patient; contraceptives; and         Family Planning Clinics do not provide
                                                                            certain lab services.                    services to pregnant women.

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            Shelton Evans
Health Centers                                                              furnished by physicians, nurse           provided: 1) Encounter visits; 2)             225/342-6253
(FQHC)                                                                      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.

Hearing Aids - See    Durable Medical    Medicaid recipients 0 through 20   Hearing Aids and any related             All services must be Prior Authorized         Stephanie Young
Durable Medical       Equipment          years of age.                      ancillary equipment such as              and the DME provider will arrange for the     225/342-3935
Equipment             Provider                                              earpieces, batteries, etc. Repairs are   request of Prior Authorization.
                                                                            covered if the Hearing Aid was paid                                                    Sylvia Green
                                                                            for by Medicaid.                                                                       225/342-1247




                                                                                      8 
 
MEDICAID SERVICES
                      HOW TO
                                                                                                                                                                      CONTACT
SERVICE               ACCESS             ELIGIBILITY                            COVERED SERVICES                          COMMENTS
                                                                                                                                                                      PERSON
                      SERVICES


Hemodialysis          Dialysis Centers   All Medicaid recipients.               Dialysis treatment (including routine                                                 Melissa Jacobs
Services - See                                                                  laboratory services); medically                                                       225/342-3870
Hospital-Outpatient   Hospitals                                                 necessary non-routine lab services;
Services                                                                        and medically necessary injections.

Home Health           Physician          All Medicaid recipients.              • Intermittent/part-time nursing           Recipients receiving Home Health must       Rhonda
                                                                                   services including skilled nurse       have physician’s prescription and signed    Habisreitinger
                                         Medically Needy (Type Case 20 &           visits.                                plan of care.                               225/342-4839
                                         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       Rhonda
Extended                                 years of age.                          services.                                 services must have a letter of medical      Habisreitinger
                                                                                                                          necessity and physician’s prescription.     225/342-4839
                                                                                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.              Rate & Audit Unit                           Lana Ryland
                      Provider/                                                                                                                                       225/342-5255
                      Physician
                                                                                                                                                                      Deloris Young
                                                                                                                                                                      225/342-1417




                                                                                          9 
 
MEDICAID SERVICES
                      HOW TO
                                                                                                                                                              CONTACT
SERVICE               ACCESS       ELIGIBILITY                           COVERED SERVICES                        COMMENTS
                                                                                                                                                              PERSON
                      SERVICES


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                         21) under age 22 are not eligible                                             Room Services                                contact an MMIS
Services, including                for Inpatient Psychiatric Services.                                                                                        Staff Member at
Emergency Room                                                                                                                                                225/342-3855 if
Services                                                                                                                                                      the issue cannot be
                                                                                                                                                              resolved

                                                                                                                                                              Providers should
                                                                                                                                                              contact Provider
                                                                                                                                                              Relations at
                                                                                                                                                              1-800-473-2783

Hospital -            Physician/   All Medicaid recipients.              Inpatient hospital care needed for      Inpatient hospitalization requires Pre-      Kellea Lacroix
Inpatient Services    Hospital                                           the treatment of an illness or injury   certification and Length of Stay             225/342-7882
                                   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     Barton Johnson
                                   for Inpatient Psychiatric Services.                                           Certification Unit.                          225/342-9475
                                                                         Includes those basic services that a
                                                                         hospital is expected to provide.

Hospital -            Physician/   All Medicaid recipients.              Diagnostic & therapeutic outpatient     Outpatient rehabilitation services require   Kellea Lacroix
Outpatient            Hospital                                           services, including outpatient          Prior Authorization. Provider will           225/342-7882
Services                                                                 surgery and rehabilitation services.    submit request for Prior Authorization.
                                                                                                                                                              Barton Johnson
                                                                         Therapeutic and diagnostic                                                           225/342-9475
                                                                         radiology services.
                                                                         Chemotherapy
                                                                         Hemodialysis




                                                                                  10 
 
MEDICAID SERVICES
                      HOW TO
                                                                                                                                                      CONTACT
SERVICE               ACCESS           ELIGIBILITY                         COVERED SERVICES                COMMENTS
                                                                                                                                                      PERSON
                      SERVICES


Hospital -            Physician/       All Medicaid recipients.            Emergency Room services.        Recipients 0 to 21 years - No service      Kellea Lacroix
Emergency Room        Hospital                                                                             limits.                                    225/342-7882
Services
                                                                                                           Recipients 21 and older - Limited to 3     Barton Johnson
                                                                                                           emergency room visits per calendar year    225/342-9475
                                                                                                           (January 1 - December 31).
                                                                                                           CommunityCARE Recipients have no
                                                                                                           limit.
Immunizations
See FQHC;
KIDMED;
Physician/Professio
nal Services; Rural
Health Clinics

KIDMED -              Louisiana        All Medicaid recipients 0 through   Medical Screenings (including   Recipients are linked to KIDMED            Brian Bagdan
EPSDT Services        KIDMED           20 years of age.                    immunizations and certain lab   providers for screening services. The      225/342-1461
                      (ACS)                                                services).                      provider is usually the primary care
                      (800) 259-4444                                                                       physician (PCP) or someone designated by
                                                                           Vision Screenings               the PCP.

                      Specialty Care                                       Hearing Screenings              KIDMED providers identify suspected
                      Resource Line:                                                                       conditions and make necessary referrals
                      (877) 455-9955                                       Dental Screenings               for treatment.

                                                                           Periodic and Interperiodic      ACS will link recipients to providers.
                                                                           Screenings




                                                                                    11 
 
MEDICAID SERVICES
                      HOW TO
                                                                                                                                                                      CONTACT
SERVICE               ACCESS            ELIGIBILITY                            COVERED SERVICES                        COMMENTS
                                                                                                                                                                      PERSON
                      SERVICES


Laboratory Tests      Physician         All Medicaid recipients.               Most diagnostic testing and                                                            Kenyatta Esters
and                                                                            radiological services ordered by the                                                   225/342-9319
X-Ray Services                                                                 attending or consulting physician.

                                                                               Portable (mobile) x-rays are covered
                                                                               only for recipients who are unable to
                                                                               leave their place of residence
                                                                               without special transportation or
                                                                               assistance to obtain physician
                                                                               ordered x-rays.


Long Term -           Office of Aging   All Medicaid recipients age 65 or      -Basic personal care-toileting &        Recipients or the responsible                  Carol Vining
Personal Care         and Adult         older, or age 21 or older with         grooming activities.                    representative must request the service.       225/342-8487
Services              Services (OAAS)   disabilities (meets Social Security    -Assistance with bladder and/or         This program is NOT a substitute for
                                        Administration disability criteria),   bowel requirements or problems.         existing family and/or community
(LT-PCS)              Contact:          meet the medical standards for         -Assistance with eating and food        supports, but is designed to supplement
                      Affiliated        admission to a nursing facility and    preparation.                            available supports to maintain the recipient
(See EPSDT            Computer          imminent risk criteria, and be able    -Performance of incidental              in the community.
Personal Care         Services (ACS)    to participate in his/her care and     household chores, only for the          Once approved for services, the selected
Services for          1-877-456-1146    direct the services provided by the    recipient.                              PCS Agency must obtain Prior
Medicaid recipients                     worker independently or through a      -Accompanying, not transporting,        Authorization.
ages 0 to 21)                           responsible representative.            recipient to medical appointments.      Units approved will be based on medical
                                        Applicant must require at least        -Grocery shopping, including            necessity and the need for covered
                                        limited assistance with at least one   personal hygiene items.                 services.
                                        Activity of Daily Living.                                                      Provided by PCS agencies enrolled in
                                                                               Does NOT cover any medical tasks        Medicaid.
                                                                               such as medication administration,
                                                                               tube feedings.

                                                                               Does NOT provide supervision for
                                                                               an individual who cannot be left at
                                                                               home alone or provide respite for a
                                                                               primary caregiver.




                                                                                        12 
 
MEDICAID SERVICES
                  HOW TO
                                                                                                                                                           CONTACT
SERVICE           ACCESS             ELIGIBILITY                      COVERED SERVICES                        COMMENTS
                                                                                                                                                           PERSON
                  SERVICES


Medical           Emergency          All Medicaid recipients.         Emergency ambulance services 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
                                                                      inadvisable for transport of the
                                                                      patient.

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
                                                                      to be a Medicaid enrolled provider      Prior Authorization.
                  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 16 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




                                                                               13 
 
MEDICAID SERVICES
                   HOW TO
                                                                                                                                                           CONTACT
SERVICE            ACCESS              ELIGIBILITY                        COVERED SERVICES                        COMMENTS
                                                                                                                                                           PERSON
                   SERVICES


Mental Health      Contact the local   All Medicaid recipients.           Clinic services including evaluations                                            Pamela Brown
Clinics            Office of Mental                                       and assessments, treatment, and                                                  225/342-6255
                   Health                                                 counseling services. Medication
                                                                          management and injections are also                                               Wendy McGraw
                                                                          covered.                                                                         225/342-4423

Mental Health      Contact a MHR       Medicaid recipients who meet the   •   Assessment                          All services must be Prior Authorized.   Pamela Brown
Rehabilitation     provider.           eligibility requirements for the   •   Service Planning                                                             225/342-6255
Services           (For a list of      program.                           •   Community Support
                   providers in your                                      •   Medication Management                                                        Wendy McGraw
                   area, contact the                                      •   Individual                                                                   225/342-4423
                   Specialty Care                                             Intervention/Supportive
                   Resource Line at                                           Counseling
                   1-877-455-9955)                                        •   Group Counseling
                                                                          •   Parent/Family Intervention-
                                                                              Counseling
                                                                          •   Psychosocial Skills Group
                                                                              Training
                                                                          •   Parent Family Intervention -
                                                                              Intensive

Midwife Services                                                                                                                                           Midwife Services
(Certified Nurse                                                                                                                                           (Certified Nurse
Midwife) - See                                                                                                                                             Midwife) - See
FQHC; Physician/                                                                                                                                           FQHC; Physician/
Professional                                                                                                                                               Professional
Services; Rural                                                                                                                                            Services; Rural
Health Clinics                                                                                                                                             Health Clinics
                   Contact a MST                                                                                                                           Toni Bennett
Multi Systemic     provider. For a     Medicaid recipients who meet the   •    Assessment                                                                  225/342-9403
Therapy            list of providers   eligibility requirements for the   •    Individual & Family Therapy                                                 (Eff. 12/1/08)
                   contact the         program.                           •    Peer Intervention
                   Specialty Care                                         •    Crisis Stabilization                                                        Wendy McGraw
                   Resource Line at                                                                                                                        225/342-4423
                   1-877-455-9955.


                                                                                    14 
 
MEDICAID SERVICES
                      HOW TO
                                                                                                                                                                      CONTACT
SERVICE               ACCESS               ELIGIBILITY                COVERED SERVICES                             COMMENTS
                                                                                                                                                                      PERSON
                      SERVICES

Occupational                                                                                                                                                          Occupational
Therapy Services                                                                                                                                                      Therapy Services
See EarlySteps;                                                                                                                                                       See EarlySteps;
Home Health;                                                                                                                                                          Home Health;
Hospital-Outpatient                                                                                                                                                   Hospital-
Services;                                                                                                                                                             Outpatient
Rehabilitation                                                                                                                                                        Services;
Clinic Services;                                                                                                                                                      Rehabilitation
Therapy Services                                                                                                                                                      Clinic Services;
                                                                                                                                                                      Therapy 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           Wendy McGraw
                      Optical Supplier                                conditions, including examinations for       medically necessary for EPSDT eligibles            225/342-4423
                                                                      vision correction, refraction error.         requires Prior Authorization. The provider
                                                                                                                   will submit requests for the Prior
                                                                                                                                                                      Cordelia Clay
                                                                      Regular eyeglasses when they meet a          Authorization. A prior authorization approval
                                                                      certain minimum strength requirement.        does not guarantee patient eligibility.            225/342-4182
                                                                      Medically necessary specialty eyewear                                                           (eyeglasses/
                                                                      and contact lenses with prior                Prescriptions are required for all                 eyewear)
                                                                      authorization. Contact lenses are            glasses/contacts. After a prescription is
                                                                      covered if they are the only means for       obtained, the recipient may see an optical
                                                                      restoring vision.                            supplier to receive the glasses/contacts.

                                                                      Other related services, if medically
                                                                      necessary.
                                                                      _____________________________                __________________________________

                                                                      Recipients 21 and over                       Recipients 21 and over                             Kenyatta Esters
                                                                                                                                                                      225/342-9319
                                                                      Examinations and treatment of eye            NON-COVERED SERVICES:                              (Optical services
                                                                      conditions, such as infections, cataracts,   - routine eye examinations for vision correction   other than
                                                                      etc.                                         - routine eye examinations for refraction error
                                                                                                                                                                      eyeglasses/
                                                                                                                   - eyeglasses
                                                                      If the recipient has both Medicare and                                                          eyewear)
                                                                      Medicaid, some vision related services
                                                                      may be covered. The recipient should
                                                                      contact Medicare for more information
                                                                      since Medicare would be the primary
                                                                      payer.



                                                                                 15 
 
MEDICAID SERVICES
                       HOW TO
                                                                                                                                                               CONTACT
SERVICE                ACCESS            ELIGIBILITY                          COVERED SERVICES                     COMMENTS
                                                                                                                                                               PERSON
                       SERVICES


Orthodontic
Services - See
Dental Care
Services

Nurse
Practitioners/
Clinical Nurse
Specialists -
See FQHC;
Physician/
Professional
Services;
Rural Health Clinics

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            Services (OAAS)   provider service area and are        care                                   quality of life.
(PACE)*                                  certified to need nursing facility
                       Contact:          level of care. Participation is                                           - Interdisciplinary team performs
                       PACE GNO at       voluntary and enrollees may                                                 assessment and develops individualized
*Program available     (504)945-1531     disenroll at any time.                                                      plan of care.
in Greater New
Orleans area.                                                                                                      - Each PACE program serves a specific
                       Franciscan                                                                                    geographic region.
**Program in Baton     PACE
Rouge area             Baton Rouge:                                                                                - PACE programs bear financial risk for
scheduled to open in   (225) 765-8233                                                                                all medical support services required
early summer of                                                                                                      for enrollees.
2008
                                                                                                                   - PACE programs receive a monthly
                                                                                                                     capitated payment for Medicaid and
                                                                                                                     Medicare eligible enrollees.




                                                                                       16 
 
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        M.J. Terrebonne
                                   some who are Medicare/Medicaid        Cosmetic drugs (Except            except for some recipient categories.         225/342-9768
                                   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
                                   dual eligible (Medicare/Medicaid)     Fertility drugs when used for     Term Care.
                                   received their pharmacy benefits    fertility
                                   through Medicare Part D.              treatment;                        Prescription limits: 8/month (The
                                                                         Experimental drugs;               physician can override this limit when
                                                                         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




                                                                                17 
 
MEDICAID SERVICES
                       HOW TO
                                                                                                                                                              CONTACT
SERVICE                ACCESS          ELIGIBILITY                     COVERED SERVICES                          COMMENTS
                                                                                                                                                              PERSON
                       SERVICES


Physician
Assistants - See
FQHC; Physician/
Professional
Services;
Rural Health Clinics


Physician/             Physician or    All Medicaid recipients.        Professional medical services             Some services require Prior                  Kenyatta Esters
Professional           Healthcare                                      including those of a physician, nurse     Authorization. Providers will submit         225/342-9319
Services               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,        Kenyatta Esters
                                                                                                                 and restrictions apply. Providers will       225/342-9319
                                                                       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.                      Kenyatta Esters
Services               Healthcare      child bearing age.              Other pre- & post-natal care and                                                       225/342-9319
                       Professional                                    delivery.
                                                                       Lab and radiology services.




                                                                                 18 
 
MEDICAID SERVICES
                       HOW TO
                                                                                                                                                         CONTACT
SERVICE                ACCESS              ELIGIBILITY                COVERED SERVICES                       COMMENTS
                                                                                                                                                         PERSON
                       SERVICES

Psychiatric
Hospital Care
Services - See
Hospital-Inpatient
Services

Psychological
Evaluation and
Therapy Services -
See Earlysteps;
EPSDT
Psychological and
Behavioral Services;
FQHC; Rural
Health Clinics;
Therapy Services-
School Boards

Rehabilitation         Physician           All Medicaid recipients    Occupational Therapy                   All services must be Prior Authorized.      Rhonda
Clinic Services                                                       Physical Therapy                                                                   Habisreitinger
                                                                      Speech, Language and Hearing           The provider of services will submit the    225/342-4839
                                                                      Therapy                                request for Prior Authorization.

Rural Health           Rural Health        All Medicaid recipients    Professional medical services          There are 3 components that may be          Shelton Evans
Clinics                Clinic                                         furnished by physicians, nurse         provided: 1) Encounter visits; 2)           225/342-6253
                                                                      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               Local Health Unit   All Medicaid recipients.   Testing, counseling, and treatment                                                 Sylvia Green
Transmitted                                                           of all sexually transmitted diseases                                               225/342-1247
Disease Clinics                                                       (STD). Confidential HIV testing.
(STD)




                                                                               19 
 
MEDICAID SERVICES
                       HOW TO
                                                                                                                                                                 CONTACT
SERVICE                ACCESS             ELIGIBILITY                           COVERED SERVICES                      COMMENTS
                                                                                                                                                                 PERSON
                       SERVICES

Speech and
Language
Evaluation and
Therapy – See
EarlySteps; Home
Health; Hospital-
Outpatient Services;
Rehabilitation
Clinic Services;
Therapy Services

Substance Abuse        Office of          Medicaid recipient 0 to 21 years of   • Individual, Group and Family        • Services are provided by the Office of   Wendy McGraw
Clinic Services        Addictive          age                                     Counseling                            Addictive Disorders                      225/342-4423
                       Disorders                                                • Medical treatment                   • Recipients must be diagnosed with an
                       1-800-662-4357                                           • Medical injections                    addictive disorder prior to receiving
                                                                                • Psychosocial, Psychiatric,            services
                       Physician                                                  Medical, and other evaluations

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.
                       Complaints Line:   Citizens with Developmental
                       (1-800-660-0488)   Disabilities
                                          District/Authority/Local Regional
                                          Office (See Appendix for
                                          telephone numbers).




                                                                                         20 
 
MEDICAID SERVICES
                 HOW TO
                                                                                                                                                            CONTACT
SERVICE          ACCESS              ELIGIBILITY                           COVERED SERVICES                     COMMENTS
                                                                                                                                                            PERSON
                 SERVICES

                                                                                                                                                            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 Elderly and Disabled Adult        services. The Support Coordinator    DHH, Office of Aging and Adult Services     1-866-758-5035
Services (Case   Services (OAAS)     (EDA) Waiver.                         (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
Elderly and                          There is a Request for Services       coordinate care.                                                                 Susan Ingram at
Disabled Adult   Complaints Line:    Registry (RFSR) for those                                                                                              225/342-2778
(EDA) Waiver     (1-800-660-0488)    requesting EDA Waiver services.
                                     Contact Louisiana Options in Long
                                     Term Care at 1-877-456-1146 for
                                     information and assistance with the
                                     EDA RFSR.

Support          SRI                 Must be Medicaid eligible and on      Coordination of Medicaid and other   Support Coordination Services must be       Lou Ann Owen
Coordination     (1-800-364-7828)    the DD Request for Services           services. The Support Coordinator    prior authorized by DHH, BHSF, Waiver       225/342-6248
Services (Case                       Registry prior to receipt of case     (Case Manager) helps to identify     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 (See Appendix for
                                     telephone numbers).




                                                                                   21 
 
MEDICAID SERVICES
                    HOW TO
                                                                                                                                                              CONTACT
SERVICE             ACCESS             ELIGIBILITY                          COVERED SERVICES                      COMMENTS
                                                                                                                                                              PERSON
                    SERVICES


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 Aging and Adult Services     Participants call
Services (Case      and HIV Support                                         (Case Manager) helps to identify      (OAAS). The provider will submit            1-866-758-5035
Management) - HIV   Coordination                                            needs, access services and            requests for the Prior Authorization.
                    Agencies                                                coordinate care.                                                                  Providers call
                                                                                                                                                              Susan Ingram at
                    Office of Public                                                                                                                          225/342-2778
                    Health
                    (504)568-7474

Support             Office for         Medicaid recipients must be 0 to 3   Coordination of Medicaid and other    Services must be authorized by OCDD.        Brenda Sharp
Coordination        Citizens with      years of age and have a              services. The Support Coordinator     The provider will submit requests for the   225/342-8853
Services (Case      Developmental      developmental delay or an            (Case Manager) helps to identify      Authorization.
Management) -       Disabilities       established medical condition.       needs, access services and
Infants and         (OCDD)                                                  coordinate care.
Toddlers
                    1-866-783-5553

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 (See Appendix for
                                       telephone numbers).




                                                                                     22 
 
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 (See Appendix for
                                       telephone numbers).

Therapy Services   Recipients have     Medicaid recipients birth through    • Audiological Services (Available   Covered services can be provided in the       Brian Bagdan
                   the choice of       20 years of age.                        in Rehabilitation Clinic and      home through Home Health and                  225/342-1461
                   services from the                                           Hospital-Outpatient settings      Rehabilitation Clinics. Services provided
                   following                                                   only.)                            by Rehabilitation Clinics can also be
                   provider types:                                          • Occupational Therapy               provided at the clinic. Services provided
                   Home Health;                                             • Physical Therapy                   through Hospital-Outpatient Services must
                   Hospital-                                                • Speech & Language Therapy          be provided at the facility/clinic. Covered
                   Outpatient                                                                                    services may be provided in addition to
                   Services;                                                                                     services provided by EarlySteps/EICs or
                   Rehabilitation                                                                                School Boards if prescribed by a physician
                   Clinic Services                                                                               and Prior Authorized.

                                                                                                                 All medically necessary services must be
                                                                                                                 prescribed by a physician and Prior
                                                                                                                 Authorization is required. The provider
                                                                                                                 of services will submit requests for Prior
                                                                                                                 Authorization.




                                                                                     23 
 
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      Brian Bagdan
continued          Services-Early      of age.                             •   Occupational Therapy               and EarlySteps must be included in the      225/342-1461
                   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 School        Brian Bagdan
continued          Services-School     years of age.                          Therapy                             Board.                                      225/342-1461
                   Board                                                   • Occupational Therapy Evaluation
                                                                              and Treatment services              All EPSDT Health Services must be
                                                                           • Physical Therapy Evaluation and      included in the child’s Individualized
                                                                              Treatment services                  Education Program (IEP).
                                                                           • Speech & Language Evaluation         If services are provided by a School
                                                                              and Therapy                         Board, Prior Authorization requirements
                                                                           • Psychological Evaluation             are met through inclusion of services on
                                                                              including a battery of tests,       the IEP.
                                                                              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       Local Health Unit   All Medicaid recipients             Treatment and disease management                                                   Sylvia Green
Clinics                                                                    services including physician visits,                                               225/342-1247
                                                                           medications, and x-rays.



                                                                                     24 
 
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                                                                                          Susan Ingram at
                    Options in Long     Medicaid standards or SSI                                                                                              225/342-2778
                    Term Care           disability criteria, meet Medicaid
                    (1-877-456-1146)    financial eligibility, imminent risk
                                        criteria and meet the criteria for
                                        admission to a nursing facility

Children’s Choice   Office for          Child must be on the DD Request        - Center Based Respite             There is a $17,000 limit per individual      Telsia Porche
                    Citizens with       for Services Registry, less than 19                                       plan year. ($1500 for Case Management        225/342-0943
                                                                               -Environmental Accessibility
                    Developmental       years old, disabled according to                                          and $15,500 for other services).
                    Disabilities        SSI criteria, require ICF/DD level      Adaptation                        *Call 1-866-783-5553 for status on the
                    Districts/          of care, have income less than 3                                          Request for Services Registry.
                                                                               -Family Training
                    Authorities/Local   times SSI amount, resources less
                    Regional Offices    than $2,000 and meet all Medicaid      -Family Support                    Complaints Line:
                    (SYSTEM ENTRY       non-financial requirements.                                               1-800-660-0488
                                                                               -Crisis Support
                    ONLY)
                                                                               -Non-Crisis Support
                    (See Appendix for
                                                                               -Support Coordination
                    telephone
                    numbers)



                                                                                        25 
 
MEDICAID SERVICES
                  HOW TO
                                                                                                                                                                    CONTACT
SERVICE           ACCESS               ELIGIBILITY                            COVERED SERVICES                         COMMENTS
                                                                                                                                                                    PERSON
                  SERVICES


Elderly and       Office of Aging      Individuals 65 years of age or         - Support Coordination                   This is a home and community-based           Applicants/
Disabled Adult    and Adult            older, who meet Medicaid financial     - Companion Service                      alternative to nursing facility placement.   Participants call
(EDA)             Services (OAAS)      eligibility, imminent risk criteria    - Environmental Accessibility                                                         1-866-758-5035
                                       and meet the criteria for admission    Adaptation
                  Contact:             to a nursing facility; or age 21-64    - Personal Emergency Response                                                         Providers call
                  Louisiana            who are disabled according to          System (PERS)                                                                         Susan Ingram at
                  Options in Long      Medicaid standards or SSI              -Transition Intensive Support                                                         225/342-2778
                  Term Care            disability criteria, meet Medicaid     Coordination
                   (1-877-456-         financial eligibility, imminent risk   -Transition Service
                  1146)                criteria and meet the criteria for
                                       admission to a nursing facility
                                                                                                                                                                    Tai Rashadeen
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




                                                                                        26 
 
MEDICAID SERVICES
                    HOW TO
                                                                                                                                                                 CONTACT
SERVICE             ACCESS               ELIGIBILITY                             COVERED SERVICES                       COMMENTS
                                                                                                                                                                 PERSON
                    SERVICES


New Opportunities   Office for           Individuals three(3) years of age or    An array of services to provide        *Call 1-866-783-5553 for status on the   Candace Ricard
Waiver (NOW)        Citizens with        older, who have a developmental         support to maintain persons in the     Request for Services Registry.           225/342-4464
                    Developmental        disability which manifested prior to    community:
                    Disabilities         the age of 22, and who meet both                                               Complaints Line:
                    Districts/Authorit   SSI Disability criteria and the level   Individual Family Support, Day and     1-800-660-0488
                    ies/Local            of care determination for an            Night; Day and Night; Shared
                    Regional Offices     ICF/DD.                                 Supports; Center Based Respite
                    (SYSTEM ENTRY                                                Care; Community Integration
                    ONLY)                                                        Development; Environmental
                    (See Appendix for                                            Accessibility Adaptations,
                    telephone                                                    Specialized Medical Equipment and
                    numbers)                                                     Supplies; Substitute Family Care
                                                                                 Services; Supported Living; Day
                                                                                 Habilitation; Supported
                                                                                 Employment; Employment-Related
                                                                                 Training; Professional Services; One
                                                                                 Transitional Expense; Skilled
                                                                                 Nursing; and Personal Emergency
                                                                                 Response System.

Supports Waiver     Office for           Individuals age 18 and older who        Covered services include: Support      Call 1-866-783-5553 for status on the    Jean Melanson
                    Citizens with        have been diagnosed with a              Coordination, Supported                Request for Services Registry            225/342-8877
                    Developmental        Developmental Disability which          Employment, Day Habilitation, Pre-
                    Disabilities         manifested prior to age 22. (Must       Vocational, Habilitation, Respite,     Complaints Line: 1-800-660-0488
                    Districts/Authorit   meet the Louisiana definition of        and Personal Emergency Response
                    ies/Local            DD).                                    System
                    Regional Offices
                    (System Entry
                    Only)



* 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.



                                                                                          27 
 
                                   APPENDIX

              OFFICE FOR CITIZENS WITH DEVELOPMENTAL DISABILITIES
                                     CSRAs

METROPOLITAN HUMAN                             REGION VI
SERVICES DISTRICT                              Nora H. Dorsey, CSRA
Rose Andrews, Acting CSRA                      429 Murray Street-Suite B
1010 Common Street, 5th Floor                  Alexandria, LA 71301
New Orleans, LA 70112                          Phone: (318) 484-2347
Phone: (504) 599-0245                          FAX: (318) 484-2458
FAX: (504) 568-4660                            Toll Free: 1-800-640-7494
Toll Free: 1-800-889-2975

CAPITAL AREA HUMAN SERVICES DISTRICT           REGION VII
Jack Johnson, CSRA                             Rebecca Thomas, CSRA
7173 Florida Blvd Ste 200-B                    3018 Old Minden Road
Baton Rouge, LA 70806                          Suite 1211
Phone: (225) 925-7182                          Bossier City, LA 71112
FAX: (225) 925-1966                            Phone: (318) 741-7455
Toll Free: 1-800-768-8824                      FAX: (318) 741-7445
                                               Toll Free: 1-800-862-1409

REGION III                                     REGION VIII
John Hall, CSRA                                Deanne W. Groves, CSRA
690 E. First Street                            122 St. John St.-Rm. 343
Thibodaux, LA 70301                            Monroe, LA 71201
Phone: (985) 449-5167                          Phone: (318) 362-3396
FAX: (985) 449-5180                            FAX: (318) 362-5305
Toll Free: 1-800-861-0241                      Toll Free: 1-800-637-3113

REGION IV                                      FLORIDA PARISHES
Richard Landry, CSRA                           HUMAN SERVICES
214 Jefferson Street - Suite 301               AUTHORITY
Lafayette, LA 70501                            Marie Gros, CSRA
Phone: (337) 262-5610                          21454 Koop Drive - Suite 2H
FAX: (337) 262-5233                            Mandeville, LA 70471
Toll Free: 1-800-648-1484                      Phone: (985) 871-8300
                                               FAX: (985) 871-8303
                                               Toll Free: 1-800-866-0806

REGION V                                       JEFFERSON PARISH
Connie Mead, CSRA                              HUMAN SERVICES
3501 Fifth Avenue, Suite C2                    AUTHORITY
Lake Charles, LA 70607                         Stephanie Campo, CSRA
Phone: (337) 475-8045                          3300 W. Esplanade Ave, Ste 213
FAX: (337) 475-8055                            Metairie, LA 70002
Toll Free: 1-800-631-8810                      Phone: (504) 838-5357
                                               FAX: (504)838-5400



                                      28 
 

				
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