Page 2
Louisiana Medicaid Eligibility Manual Medical Services Reissued August 20, 2024 Replacing May 30, 2023
Page 2 of C-0000 Revised/added text indicated by underscore
Deleted text indicated by “**” C-200 SERVICE LIMITS
Beneficiaries shall be advised of any limitations and/or prior authorization requirements prior to obtaining services, such as:
• Non-covered prescriptions
• Services only covered a specific number of times per calendar year
• Medical procedures or equipment that must be pre-approved
C-300 COVERED SERVICES
Behavioral Health
• A comprehensive package of behavioral health services for eligible beneficiaries provided through the Louisiana Behavioral Health Partnership (LBHP). Delivery of services is managed by a single Statewide Management Organization (SMO)
Case Management
• Individualized planning and service coordination for certain defined groups
Clinic Services
• Rural Health, Family Planning, Mental Health, Substance Abuse, Free-Standing End-Stage Renal Disease, Radiation Therapy, Prenatal, Ambulatory Surgical Centers, Sexually- Transmitted Disease, and Tuberculosis clinic services
Dental Services
• Limited to dentures and treatment for traumatic injury, malignancies or suspected malignancies for beneficiaries age 21 and over
• A full range of dental services for beneficiaries under age 21 as EPSDT services, in accordance with an approved treatment plan