La. Admin. Code tit. 50 § XXIII-303

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

Section XXIII-303 - Services Provided

A. The PACE benefit package for all participants, regardless of the source of payment, must include:

1. all Medicaid-covered services, as specified in the state's approved Medicaid plan;

2. interdisciplinary assessment and treatment planning;

3. primary care, including physician and nursing services;

4. social services;

5. behavioral health services;

a. - c. Repealed.

6. restorative therapies, including:

a. physical therapy;

b. occupational therapy; and

c. speech-language pathology services;

7. personal care and supportive services;

8. nutrition counseling;

9. recreational therapy;

10. transportation;

11. meals;

a. - y. Repealed.

12. medical specialty services including, but not limited to:

a. anesthesiology;

b. audiology;

c. cardiology;

d. dentistry;

e. dermatology;

f. gastroenterology;

g. gynecology;

h. internal medicine;

i. nephrology;

j. neurosurgery;

k. oncology;

l. ophthalmology;

m. oral surgery;

n. orthopedic surgery;

o. otorhinolaryngology;

p. plastic surgery;

q. pharmacy consulting services;

r. podiatry;

s. psychiatry;

t. pulmonary disease;

u. radiology;

v. rheumatology;

w. general surgery;

x. thoracic and vascular surgery; and

y. urology;

13. laboratory tests, x-rays, and other diagnostic procedures;

14. drugs and biologicals;

a. - d. Repealed.

15. prosthetics, orthotics, durable medical equipment, corrective vision devices, such as:

a. eyeglasses and lenses;

b. hearing aids;

c. dentures;

d. repair and maintenance of these items; and

e. wheelchairs, including custom wheelchairs that are medically necessary;

f. - l. Repealed.

16. acute inpatient care, including:

a. ambulance;

b. emergency room care and treatment room services;

c. semi-private room and board;

d. general medical and nursing services;

e. medical surgical/intensive care/coronary care unit;

f. laboratory tests, x-rays, and other diagnostic procedures;

g. drugs and biological;

h. blood and blood derivatives;

i. surgical care, including the use of anesthesia;

j. use of oxygen;

k. physical, occupational, recreational therapies, and speech-language pathology services;

l. social services; and m. psychiatric treatment;

17. nursing facility care, including:

a. semi-private room and board;

b. physician and skilled nursing services;

c. custodial care;

d. personal care and assistance;

e. drugs and biologicals;

f. physical, occupational, recreational therapies, and speech-language pathology, if necessary;

g. social services; and

h. medical supplies and appliances;

18. other services determined necessary by the interdisciplinary team to improve and maintain the participant's overall health status.

La. Admin. Code tit. 50, § XXIII-303

Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 30:245 (February 2004), Amended by the Department of Health, Bureau of Health Services Financing and the Office of Aging and Adult Services, LR 50400 (3/1/2024).

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254, Title XIX of the Social Security Act, and 42 CFR 460 et seq.