La. Admin. Code tit. 50 § XV-7305
Current through Register Vol. 50, No. 11, November 20, 2024
Section XV-7305 - Beneficiary QualificationsA. Conditions for Provision of EPSDT Personal Care Services 1. The person must be a categorically-eligible Medicaid beneficiary birth through 20 years of age (EPSDT eligible) and have been prescribed medically necessary, age appropriate EPSDT PCS by a practitioner (physician, advance practice nurse, or physician assistant).2. An EPSDT-eligible shall meet medical necessity criteria as established by the Bureau of Health Services Financing (BHSF) which shall be based on functional and medical eligibility and impairment in at least two activities of daily living (ADL), as determined by BHSF or its designee.3. EPSDT PCS shall be prescribed if medically necessary by the beneficiary's attending practitioner initially and every 180 days thereafter (or rolling six months), and when changes in the plan of care occur. The plan of care shall be acceptable only after the practitioner signs and dates the completed form. The practitioners signature must be an original signature and not a rubber stamp.La. Admin. Code tit. 50, § XV-7305
Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 21:947 (September 1995), repromulgated for LAC codification, LR 29:177 (February 2003), amended LR 30:253 (February 2004), Amended by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 40:2259 (November 2014), Amended by the Department of Health, Bureau of Health Services Financing, LR 45906 (7/1/2019).AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.