La. Admin. Code tit. 50 § XV-7323

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

Section XV-7323 - Nonreimbursable Services

A. The following services are not appropriate for personal care and are not reimbursable as EPSDT personal care services:

1. insertion and sterile irrigation of catheters (although changing of a catheter bag is allowable);

2. irrigation of any body cavities which require sterile procedures;

3. application of dressing, involving prescription medication and aseptic techniques, including care of mild, moderate or severe skin problems;

4. administration of injections of fluid into veins, muscles or skin;

5. administration of medicine (an EPSDT PCS direct service worker may only remind/prompt about self-administered medication to an EPSDT eligible beneficiary who is over the age of 18);

6. cleaning of the home in an area not occupied by the beneficiary;

a. Repealed.

7. laundry, other than that incidental to the care of the beneficiary;

a. Repealed.

EXAMPLE: Laundering of clothing and bedding for the entire household, as opposed to simple laundering of the beneficiary's clothing or bedding.

8. shopping for groceries or household items other than items required specifically for the health and maintenance of the beneficiary, and not for items used by the rest of the household;

9. skilled nursing services, as defined in the state Nurse Practices Act, including medical observation, recording of vital signs, teaching of diet and/or administration of medications/injections, or other delegated nursing tasks;

10. teaching a family member or friend how to care for a beneficiary who requires frequent changes of clothing or linens due to total or partial incontinence for which no bowel or bladder training program for the patient is possible;

11. specialized nursing procedures such as:

a. insertion of nasogastric feeding tube;

b. in-dwelling catheter;

c. tracheostomy care;

d. colostomy care;

e. ileostomy care;

f. venipuncture; and/or

g. injections;

12. rehabilitative services such as those administered by a physical therapist;

13. teaching a family member or friend techniques for providing specific care;

14. palliative skin care with medicated creams and ointments and/or required routine changes of surgical dressings and/or dressing changes due to chronic conditions;

15. teaching of signs and symptoms of disease process, diet and medications of any new or exacerbated disease process;

16. specialized aide procedures such as:

a. rehabilitation of the beneficiary (exercise or performance of simple procedures as an extension of physical therapy services);

b. measuring/recording the beneficiary's vital signs (temperature, pulse, respirations and/or blood pressure, etc.) or intake/output of fluids;

c. specimen collection;

d. special procedures such as:

i. nonsterile dressings;

ii. special skin care (nonmedicated);

iii. decubitus ulcers;;

iv. cast care;

v. assisting with ostomy care;

vi. assisting with catheter care;

vii. testing urine for sugar and acetone;

viii. breathing exercises;

ix. weight measurement; and

x. enemas;

17. home IV therapy;

18. custodial care or provision of only instrumental activities of daily living tasks or provision of only one activity of daily living task;

19. occupational therapy;

20. speech pathology services;

21. audiology services;

22. respiratory therapy;

23. personal comfort items;

24. durable medical equipment;

25. oxygen;

26. orthotic appliances or prosthetic devices;

27. drugs provided through the Louisiana Medicaid pharmacy program;

28. laboratory services; and

29. social worker visits.

B. - D. Repealed.

Implementation of the provisions of this Rule may be contingent upon the approval of the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS), if it is determined that submission to CMS for review and approval is required.

La. Admin. Code tit. 50, § XV-7323

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 29:179 (February 2003), Amended by the Department of Health, Bureau of Health Services Financing, LR 45908 (7/1/2019).

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