La. Admin. Code tit. 50 § XV-27701

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

Section XV-27701 - Service Coverage and Limitations

A. The Medicaid Program will reimburse a pediatric day health care facility for the following covered services:

1. nursing care;

2. respiratory care;

3. physical therapy;

4. speech-language therapy;

5. occupational therapy;

6. social services;

7. personal care services;

8. transportation to and from the PDHC facility; and

9. one or more meals and snacks per day depending on the child's length of stay.

B. Non-Covered Services. The following services do not qualify as covered PDHC services:

1. education and training services;

2. before and after school care;

3. medical equipment, supplies and appliances;

4. parenteral or enteral nutrition; or

5. infant food or formula.

C. PDHC facility services must be prescribed by the recipient's prescribing physician and an individualized plan of care must be developed for the recipient by the PDHC facility.

D. PDHC services must be prior authorized by the Medicaid Program or its approved designee. Services provided without authorization shall not be considered for reimbursement, except in the case of retroactive Medicaid eligibility.

E. Service Limitations. Services may be provided seven days per week and up to 12 hours per day for qualified Medicaid recipients as documented in the plan of care.

La. Admin. Code tit. 50, § XV-27701

Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 36:1557 (July 2010).

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