La. Admin. Code tit. 50 § I-10103

Current through Register Vol. 50, No. 11, November 20, 2024

Section I-10103 - Benefits and Services

A. Minimum Essential Health Benefits. Pursuant to §1302(b) of ACA, the ABP must provide the new adult group with a benchmark benefit or benchmark-equivalent benefit package that includes the required minimum essential health benefits (EHBs) provided in affordable insurance exchanges. There are 10 benefit categories and some of the categories include more than one type of benefit. The following services are considered EHBs:

1. ambulatory patient services;

2. emergency services;

3. hospitalization;

4. maternity and newborn care;

5. mental health and substance use disorder services, including behavioral health treatment:

a. these services shall be in accordance with the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008;

6. prescription drugs;

7. rehabilitative and habilitative services and devices;

8. laboratory services;

9. preventive services and chronic disease management; and

10. pediatric services, including oral and vision care.

a. The requirements of this service category are met through the Early and Periodic Screening, Diagnosis and Treatment Program.

B. Enrollees shall receive the full range of benefits and services covered under the ABP state plan amendment. The ABP package will incorporate the benefits and services covered under the Medicaid State Plan, including the essential health benefits as provided in §1302(b) of ACA.

La. Admin. Code tit. 50, § I-10103

Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 42756 (5/1/2016).

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.