La. Admin. Code tit. 50 § XXXIII-103

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

Section XXXIII-103 - Recipient Participation

A. The following Medicaid recipients shall be mandatory participants for integrated specialized behavioral health and physical health services:

1. children who are blind or have a disability and related populations, under age 18;

2. aged and related populations, age 65 and older who are not blind, do not have a disability, and are not members of the §1931 adult population;

3. children who receive foster care or adoption assistance (title IV-E), or who are in foster care or who are otherwise in an out-of-home placement;

4. children with special health care needs as defined in §1932(a);

5. Native Americans;

6. full dual eligibles (for behavioral health services only and non-emergency medical transportation (NEMT);

7. children residing in an intermediate care facility for persons with intellectual disabilities (for behavioral health services only and NEMT);

8. all enrollees of waiver programs administered by the LDH Office for Citizens with Developmental Disabilities (OCDD) or the LDH Office of Aging and Adult Services (OAAS) (mandatory for behavioral health services only and NEMT);

9. all Medicaid children functionally eligible for the CSoC;

10. adults residing in a nursing facility (for behavioral health services only and NEMT);

11. supplemental security income/transfer of resources/long-term care related adults and children (for behavioral health services only and NEMT); and

12. transfer of resources/long-term care adults and children (for behavioral health services only and NEMT).

B. Mandatory participants shall be automatically enrolled and disenrolled from the MCOs.

C. Notwithstanding the provisions of Subsection A of this Section, the following Medicaid recipients are excluded from enrollment in the MCOs and the CSoC contractor:

1. for adults and children:

a. refugee cash assistance;

b. refugee medical assistance;

c. spend-down medically needy;

d. specified low-income beneficiaries (SLMB)-only;

e. aliens emergency services;

f. qualified individuals (QI) 1;

g. long-term care (LTC) co-insurance;

h. qualified disabled and working individuals (QDWI); and

i. qualified medicare beneficiaries (QMB)-only; and

2. adult-only populations excluded from the 1915(b) waiver:

a. residents of an ICF/ID;

b. Program of All Inclusive Care for the Elderly (PACE); and

c. Take Charge Plus.

3.- 10. Repealed.

D. Any Medicaid eligible person is suspended from participation during a period of incarceration.

La. Admin. Code tit. 50, § XXXIII-103

Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 38:361 (February 2012), Amended by the Department of Health and Hospitals, Bureau of Health Services Financing and the Office of Behavioral Health, LR 411286 (7/1/2015), Amended by the Department of Health and Hospitals, Bureau of Health Services Financing and the Office of Behavioral Health, LR 412354 (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.