Medicaid Managed Care Policies & Procedures

In accordance with La. R.S. 46:460.51, et seq., prior to adopting, approving, amending, or implementing certain policies or procedures, LDH will publish the proposed policy or procedure for the purpose of soliciting public comments. For this purpose, a policy or procedure, as defined by the statute, shall mean a requirement governing the administration of managed care organizations specific to billing guidelines, medical management and utilization review guidelines, case management guidelines, claims processing guidelines and edits, grievance and appeals procedures and process, other guidelines or manuals containing pertinent information related to operations and pre-processing claims, and core benefits and services.

The following table contains the LDH and managed care organization policies and procedures that are open for public comment.

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Item Number	Policy/Procedure	Date Posted	Comment Period Closed	Status	Document Links
2026-ACLA-836	Pelvis MRI	4/1/26	5/16/26	Pending	Pelvis MRI
2026-ACLA-837	Pelvis MRA	4/1/26	5/16/26	Pending	Pelvis MRA
2026-ACLA-838	Pelvis CTAngiography	4/1/26	5/16/26	Pending	Pelvis CTAngiography
2026-ACLA-839	Pelvis CT	4/1/26	5/16/26	Pending	Pelvis CT
2026-ACLA-840	Neck MRA/MRV	4/1/26	5/16/26	Pending	Neck MRA/MRV
2026-ACLA-841	Neck CTA	4/1/26	5/16/26	Pending	Neck CTA
2026-ACLA-842	MUGA (Multiple Gated Acquisition) Scan	4/1/26	5/16/26	Pending	MUGA (Multiple Gated Acquisition) Scan
2026-ACLA-843	Neck CT	4/1/26	5/16/26	Pending	Neck CT
2026-ACLA-846	Lumbar Spine CT	4/1/26	5/16/26	Pending	Lumbar Spine CT
2026-ACLA-847	Lumbar Spine MRI	4/1/26	5/16/26	Pending	Lumbar Spine MRI
2026-ACLA-848	Lower Extremity MRI (foot, ankle, knee, leg, or hip MRI)	4/1/26	5/16/26	Pending	Lower Extremity MRI (foot, ankle, knee, leg, or hip MRI)
2026-ACLA-849	Lower Extremity MRA/MRV	4/1/26	5/16/26	Pending	Lower Extremity MRA/MRV
2026-ACLA-853	Heart MRI	4/1/26	5/16/26	Pending	Heart MRI
2026-ACLA-857	CT Heart, CT Heart Congenital (Not including coronary arteries)	4/1/26	5/16/26	Pending	CT Heart, CT Heart Congenital (Not including coronary arteries)
2026-ACLA-858	Upper Extremity MRA/MRV	4/1/26	5/16/26	Pending	Upper Extremity MRA/MRV
2026-ACLA-859	Upper Extremity MRI	4/1/26	5/16/26	Pending	Upper Extremity MRI
2026-ACLA-862	Upper Extremity CT	4/1/26	5/16/26	Pending	Upper Extremity CT
2026-ACLA-863	Thoracic Spine MRI	4/1/26	5/16/26	Pending	Thoracic Spine MRI
2026-ACLA-864	Lower Extremity CTA/CTV	4/1/26	5/16/26	Pending	Lower Extremity CTA/CTV
2026-ACLA-865	Upper Extremity CTA/CTV	4/1/26	5/16/26	Pending	Upper Extremity CTA/CTV
2026-ACLA-866	Thoracic Spine CT	4/1/26	5/16/26	Pending	Thoracic Spine CT
2026-ACLA-867	Temporomandibular Joint (TMJ) MRI	4/1/26	5/16/26	Pending	Temporomandibular Joint (TMJ) MRI
2026-ACLA-868	Spinal Canal MRA	4/1/26	5/16/26	Pending	Spinal Canal MRA
2026-ACLA-869	Sinus & Maxillofacial CT Limited or Localized Follow Up Sinus CT	4/1/26	5/16/26	Pending	Sinus & Maxillofacial CT Limited or Localized Follow Up Sinus CT
2026-ACLA-870	Temporal Bone, Mastoid, Orbits, Sella, Internal Auditory Canal CT	4/1/26	5/16/26	Pending	Temporal Bone, Mastoid, Orbits, Sella, Internal Auditory Canal CT
2026-ACLA-871	Sinus Face Orbit MRI	4/1/26	5/16/26	Pending	Sinus Face Orbit MRI
2026-ACLA-1448	PET Scans	4/1/26	5/16/26	Pending	PET Scans
2026-ACLA-2249	Tumor Imaging PET-Any Site (Unlisted PET)	4/1/26	5/16/26	Pending	Tumor Imaging PET-Any Site (Unlisted PET)
2026-LDH-9	MCO Manual > Louisiana Department of Children and Family Services (DCFS)	3/25/26	5/9/26	Pending	MCO Manual – DCFS
2026-LHCC-1213	Sacroiliac Joint Fusion Evolent	3/20/26	5/4/26	Pending	Sacroiliac Joint Fusion Evolent
2026-HUM-1584	Therapeutic Group Home	3/20/26	5/4/26	Pending	Therapeutic Group Home
2026-LHCC-423	EPSDT	3/20/26	5/4/26	Pending	EPSDT
2026-ABH-1331	Supporting Members in Crisis	3/20/26	5/4/26	Pending	Supporting Members in Crisis
2026-HUM-1540	Crisis Stabilization for Adults	3/20/26	5/4/26	Pending	Crisis Stabilization for Adults
2026-ACLA-2769	Call Center Manual	3/20/26	5/4/26	Pending	Call Center Manual
2026-HBL-2799	LA Provider Training	3/20/26	5/4/26	Pending	LA Provider Training
2026-ACLA-844	Low Field MRI	3/13/26	4/27/26	Pending	Low Field MRI
2026-ACLA-850	Lower Extremity CT	3/13/26	4/27/26	Pending	Lower Extremity CT
2026-ACLA-851	Low Dose CT for Lung Cancer Screening	3/13/26	4/27/26	Pending	Low Dose CT for Lung Cancer Screening
2026-ACLA-856	Functional Brain MRI	3/13/26	4/27/26	Pending	Functional Brain MRI
2026-ACLA-861	Breast MRI	3/13/26	4/27/26	Pending	Breast MRI
2026-ACLA-874	CT (Virtual) Colonoscopy	3/13/26	4/27/26	Pending	CT (Virtual) Colonoscopy
2026-ACLA-875	Chest (Thorax) CT	3/13/26	4/27/26	Pending	Chest (Thorax) CT
2026-ACLA-876	Chest CTA	3/13/26	4/27/26	Pending	Chest CTA
2026-ACLA-877	Chest MRA	3/13/26	4/27/26	Pending	Chest MRA
2026-ACLA-878	Chest (Thorax) MRI	3/13/26	4/27/26	Pending	Chest (Thorax) MRI
2026-ACLA-879	Brain (Head) MRS	3/13/26	4/27/26	Pending	Brain (Head) MRS
2026-ACLA-880	Cervical Spine MRI	3/13/26	4/27/26	Pending	Cervical Spine MRI
2026-ACLA-881	Cervical Spine CT	3/13/26	4/27/26	Pending	Cervical Spine CT
2026-ACLA-882	Brain (Head) MRI, Brain (Head) MRI with IAC (Internal Auditory Canal)	3/13/26	4/27/26	Pending	Brain (Head) MRI, Brain (Head) MRI with IAC (Internal Auditory Canal)
2026-ACLA-883	Brain (Head) CT	3/13/26	4/27/26	Pending	Brain (Head) CT
2026-ACLA-884	Brain (Head) MRA/MRV	3/13/26	4/27/26	Pending	Brain (Head) MRA/MRV
2026-ACLA-885	Brain (Head) CTA	3/13/26	4/27/26	Pending	Brain (Head) CTA
2026-ACLA-886	Bone Marrow MRI	3/13/26	4/27/26	Pending	Bone Marrow MRI
2026-ACLA-887	Abdominal Arteries CTAngiography	3/13/26	4/27/26	Pending	Abdominal Arteries CTAngiography
2026-ACLA-888	Abdomen/Pelvis CTA Combo	3/13/26	4/27/26	Pending	Abdomen/Pelvis CTA Combo
2026-ACLA-889	Abdomen MRA (Angiography)	3/13/26	4/27/26	Pending	Abdomen MRA (Angiography)
2026-ACLA-890	Abdomen/Pelvis CT Combo	3/13/26	4/27/26	Pending	Abdomen/Pelvis CT Combo
2026-ACLA-891	Abdomen MRI, MRCP	3/13/26	4/27/26	Pending	Abdomen MRI, MRCP
2026-ACLA-892	Abdomen CT	3/13/26	4/27/26	Pending	Abdomen CT
2026-ACLA-893	Abdomen CTAngiography	3/13/26	4/27/26	Pending	Abdomen CTAngiography
2026-LHCC-934	Behavioral Health Provider Quality Program	3/13/26	4/27/26	Pending	Behavioral Health Provider Quality Program
2026-ACLA-1147	Brain PET Scan	3/13/26	4/27/26	Pending	Brain PET Scan
2026-LHCC-1833	Assertive Community Treatment (ACT)	3/13/26	4/27/26	Pending	Assertive Community Treatment (ACT)
2026-LDH-1	MCO Manual > Part 4: Services > Professional Services > Obstetrics; effective date: 5/30/2026	3/9/26	4/23/26	Pending	MCO Manual - Doula Services
2026-LDH-2	MCO Manual > Part 4: Services > Pharmacy > Medication Therapy Management; effective date: 5/30/2026	3/9/26	4/23/26	Pending	MCO Manual - Cell and Gene Therapy Model
2026-LDH-3	MCO Manual > Part 4: Services > Medical Transportation; effective date: 5/30/2026	3/9/26	4/23/26	Pending	MCO Manual - Medical Transportation
2026-LDH-4	MCO Manual > Part 11: Enrollee Services > Grievances, Appeal and State Fair Hearing; effective date: 5/30/2026	3/9/26	4/23/26	Pending	MCO Manual - Grievances, Appeal and State Fair Hearing
2026-LDH-5	MCO Manual > Part 15: Program Integrity; effective date: 5/30/2026	3/9/26	4/23/26	Pending	MCO Manual - Program Integrity
2026-LDH-6	MCO Manual > Part 9: Provider Network > Credentialing and Re-Credentialing of Providers and Clinical Staff > Specialized Behavioral Health Providers; effective date: 5/30/2026	3/9/26	4/23/26	Pending	MCO Manual - Specialized Behavioral Health Providers
2026-LDH-7	MCO Manual > Part 4: Services > Professional Services > In Lieu of Services; effective date: 5/30/2026	3/9/26	4/23/26	Pending	MCO Manual - ILOS
2026-LDH-8	MCO Manual > Part 4: Services > Professional Services > Physician Adminstered Drugs; effective date: 5/30/2026	3/9/26	4/23/26	Pending	MCO Manual - Physician Administered Drugs
2026-HBL-2756	Remote Patient Monitoring In Lieu of Service (ILOS)	3/9/26	4/23/26	Pending	Remote Patient Monitoring In Lieu of Service (ILOS)
2026-ABH-1179	Prior Authorizations	3/9/26	4/23/26	Pending	Prior Authorizations
2026-LHCC-2184	Organizational Assessment and Reassessment	3/9/26	4/23/26	Pending	Organizational Assessment and Reassessment
2026-ABH-2254	Benefit Exception Amendment	3/9/26	4/23/26	Pending	Benefit Exception Amendment
2026-HBL-2790	PA Req Chngs-UM AROW CAID	3/9/26	4/23/26	Pending	PA Req Chngs-UM AROW CAID
2026-ACLA-2795	Pre-Adjudication of Provider Claims for Diagnosis Accuracy	3/9/26	4/23/26	Pending	Pre-Adjudication of Provider Claims for Diagnosis Accuracy
2026-LHCC-2450	Pharmacy Prior Authorization and Medical Necessity	2/27/26	4/13/26	Pending	Pharmacy Prior Authorization and Medical Necessity
2026-LHCC-140	Timeliness of UM Decisions	2/27/26	4/13/26	Pending	Timeliness of UM Decisions
2026-LHCC-429	UM Program Description	2/27/26	4/13/26	Pending	UM Program Description
2026-LHCC-1909	Peer Support Services	2/27/26	4/13/26	Pending	Peer Support Services
2026-LHCC-1916	Individual Placement and Support	2/27/26	4/13/26	Pending	Individual Placement and Support
2026-ABH-2253	Utilization Management Timeliness Standards and Decision Notification Amendment	2/27/26	4/13/26	Pending	Utilization Management Timeliness Standards and Decision Notification Amendment
2026-ABH-2256	Assertive Community Treatment (ACT)	2/27/26	4/13/26	Pending	Assertive Community Treatment (ACT)
2026-HBL-2496	Genetic Tests One Per Life Comms	2/27/26	4/13/26	Pending	Genetic Tests One Per Life Comms
2026-HBL-2781	EXPRESS ABA Claim Processing	2/20/26	4/6/26	Pending	EXPRESS ABA Claim Processing
2026-ACLA-1442	ACLA Prior Authorization Service List	2/20/26	4/6/26	Pending	ACLA Prior Authorization Service List
2026-LHCC-1872	Retroactive Reimbursement	2/20/26	4/6/26	Pending	Retroactive Reimbursement
2026-ABH-2362	AMA XXXX Home Health and Extended Home Health	2/20/26	4/6/26	Pending	AMA XXXX Home Health and Extended Home Health
2026-HBL-2791	Quality of Care	2/20/26	4/6/26	Pending	Quality of Care
2026-ABH-1433	Member transition	2/13/26	3/30/26	Pending	Member transition
2026-ABH-2349	Bariatric Surgery	2/13/26	3/30/26	Pending	Bariatric Surgery
2026-ABH-2350	BRCA Genetic Testing and Counseling	2/13/26	3/30/26	Pending	BRCA Genetic Testing and Counseling
2026-HUM-2767	CPT-9328	2/13/26	3/30/26	Pending	CPT-9328
2026-HUM-2768	CPT-9327	2/13/26	3/30/26	Pending	CPT-9327
2026-HUM-2778	Documentation Requirements for Hysterectomy and Sterilization	2/13/26	3/30/26	Pending	Documentation Requirements for Hysterectomy and Sterilization
2026-HUM-2788	Correct Coding	2/13/26	3/30/26	Pending	Correct Coding
2026-HBL-2794	Infusion Administration Facility Editing Update	2/13/26	3/30/26	Pending	Infusion Administration Facility Editing Update
2026-LHCC-329	Adverse Determinations	2/13/26	3/30/26	Pending	Adverse Determinations
2026-LHCC-497	Emergency Services Policy	2/13/26	3/30/26	Pending	Emergency Services Policy
2026-ABH-1173	Peer Support Services	2/13/26	3/30/26	Pending	Peer Support Services
2026-HBL-1286	Unlisted or Miscellaneous Codes	2/13/26	3/30/26	Pending	Unlisted or Miscellaneous Codes
2026-HUM-2792	Genetics	2/13/26	3/30/26	Pending	Genetics
2026-HUM-2793	CPT	2/13/26	3/30/26	Pending	CPT
2026-LHCC-1416	Transportation Policy	2/13/26	3/30/26	Pending	Transportation Policy
2026-HUM-2649	LA MCD PAL A	2/13/26	3/30/26	Pending	LA MCD PAL A
2026-HUM-2796	Durable Medical Equipment, Maintenance and Repair	2/13/26	3/30/26	Pending	Durable Medical Equipment, Maintenance and Repair