La. Admin. Code tit. 50 § XXXIII-101

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

Section XXXIII-101 - General Provisions

A. The Medicaid Program hereby adopts provisions to establish a comprehensive system of delivery for specialized behavioral health and physical health services. These services shall be administered through the Healthy Louisiana and Coordinated System of Care (CSoC) Waiver under the authority of the Department of Health (LDH), in collaboration with managed care organizations (MCOs) and the coordinated system of care (CSoC) contractor, which shall be responsible for the necessary operational and administrative functions to ensure adequate service coordination and delivery.

B. The provisions of this Rule shall apply only to the services provided to Medicaid recipients/enrollees by or through an MCO or the CSoC contractor.

C. Managed care organizations shall operate as such, and the CSoC contractor shall operate as a prepaid inpatient health plan (PIHP). The MCOs and the CSoC contractor were procured through a competitive request for proposal (RFP) process. The MCOs and CSoC contractor shall assist with the states system reform goals to support individuals with behavioral health and physical health needs in families homes, communities, schools and jobs.

D. Through the utilization of MCOs and the CSoC contractor, it is the departments goal to:

1. increase access to a broad array of evidence-based home and community-based services that promote hope, recovery and resilience;

2. improve quality by establishing and measuring outcomes;

3. manage costs through effective utilization of State, federal, and local resources; and

4. foster reliance on natural supports that sustain individuals and families in homes and communities.

E. The CSoC contractor shall be paid on a risk basis for specialized behavioral health services rendered to children/youth enrolled in the Coordinated System of Care Waiver. The MCOs shall be paid on a risk basis for specialized behavioral health and physical health services rendered to adults and children/youth.

La. Admin. Code tit. 50, § XXXIII-101

Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 38:360 (February 2012), Amended by the Department of Health and Hospitals, Bureau of Health Services Financing and the Office of Behavioral Health, LR 412353 (11/1/2015), Amended by the Department of Health, Bureau of Health Services Financing and the Office of Behavioral Health, LR 43321(2/1/2017), Amended LR 441889 (10/1/2018).

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