This Louisiana Medicaid subpart establishes coverage, provider participation requirements, and reimbursement methodology for specialized behavioral health services rendered to children and youth (under age 21) with mental health or emotional/behavioral disorders. Covered services include therapeutic services, rehabilitation services (CPST and PSR), crisis intervention, and crisis stabilization, delivered through managed care organizations and the Coordinated System of Care contractor. Providers must contract with MCOs or the CSoC contractor, deliver services within their licensed scope of practice, and document medical necessity as determined by a licensed mental health professional or physician.
View official sourceSubpart 3. Children’s Mental Health Services Chapter 21.General Provisions §2101.Introduction A.The Medicaid Program hereby adopts provisions to provide coverage under the Medicaid State Plan for mental health services rendered to children and youth with behavioral health disorders. These services shall be administered 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. The CSoC contractor shall only manage specialized behavioral health services for children and youth enrolled in the coordinated system of care. B.The specialized behavioral health services rendered to children with emotional or behavioral disorders are those services necessary to reduce the disability resulting from the illness and to restore the individual to his/her best possible functioning level in the community. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act. HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 38:364 (February 2012), amended by the Department of Health and Hospitals, Bureau of Health Services Financing and the Office of Behavioral Health, LR 41:2358 (November 2015), amended by the Department of Health, Bureau of Health Services Financing and the Office of Behavioral Health, LR 44:1892 (October 2018). §2103.Recipient Qualifications A.Individuals under the age of 21 with an identified mental health diagnosis, who meet Medicaid eligibility and clinical criteria, shall qualify to receive home and community-based behavioral health services. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act. HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 38:364 (February 2012). Chapter 23.Services §2301.General Provisions A.All specialized behavioral health services must be medically necessary. The medical necessity for services shall be determined by a licensed mental health professional (LMHP) or physician who is acting within the scope of his/her professional license and applicable state law. B.Services provided to children and youth must include communication and coordination with the family and/or legal guardian and, for children in state custody, the custodial agency. Coordination with other child-serving systems should occur as needed to achieve the treatment goals. All coordination must be documented in the child’s medical record. 1.The agency or individual who has the decision-making authority for a child or youth in state custody must request and approve the provision of services to the recipient. C.Children who are in need of specialized behavioral health services shall be served within the context of the family and not as an isolated unit. 1.Services shall be: a.delivered in a culturally and linguistically competent manner; and b.respectful of the individual receiving services. 2.Services shall be appropriate to children and youth of diverse racial, ethnic, religious, sexual, and gender identities, as well as other cultural and linguistic groups. 3.Services shall also be appropriate for: a.age; b.development; and c.education. D.Evidence-based practices require prior approval and fidelity reviews on an ongoing basis as determined necessary by the department. E.Services may be provided at a site-based facility, in the community, or in the individual’s place of residence as outlined in the treatment plan. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act. HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 38:364 (February 2012), amended by the Department of Health and Hospitals, Bureau of Health Services Financing and the Office of Behavioral Health, LR 41:2358 (November 2015), amended by the Department of Health, Bureau of Health Services Financing and the Office of Behavioral Health, LR 44:1892 (October 2018), LR 50:983 (July 2024). §2303.Covered Services A.The following behavioral health services shall be reimbursed under the Medicaid Program: 1.therapeutic services delivered by one of the following practitioners: a.psychiatrist; b.licensed mental health professional; c.provisionally licensed professional counselor; d.provisionally licensed marriage and family therapist; e.licensed master social worker; f.psychology intern from an American Psychological Association approved internship program; or g.provisionally licensed psychologist); 2.rehabilitation services, including community psychiatric support and treatment (CPST) and psychosocial rehabilitation (PSR); 3.crisis intervention services; and 4.crisis stabilization services. B.Service Exclusions. The following services shall be excluded from Medicaid reimbursement: 1.components that are not provided to, or directed exclusively toward the treatment of, the Medicaid eligible individual; 2.services provided at a work site which are job tasks oriented and not directly related to the treatment of the recipient’s needs; 3.any services or components in which the basic nature of which are to supplant housekeeping, homemaking, or basic services for the convenience of an individual receiving services; 4.services rendered in an institute for mental disease other than a psychiatric residential treatment facility (PRTF) or an inpatient psychiatric hospital; and 5.the cost of room and board associated with crisis stabilization. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act. HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 38:364 (February 2012), amended by the Department of Health and Hospitals, Bureau of Health Services Financing and the Office of Behavioral Health, LR 41:2359 (November 2015), amended by the Department of Health, Bureau of Health Services Financing and the Office of Behavioral Health, LR 44:1892 (October 2018), LR 50:983 (July 2024), amended by the Department of Health, Bureau of Health Services Financing, LR 52:496 (April 2026). Chapter 25.Provider Participation §2501.Provider Responsibilities A.Each provider of specialized behavioral health services shall enter into a contract with one or more of the managed care organizations (MCOs) and with the coordinated system of care (CSoC) contractor for youth enrolled in the Coordinated System of Care program in order to receive reimbursement for Medicaid covered services. B.Providers shall deliver all services in accordance with their license and scope of practice, federal and state laws and regulations, the provisions of this Rule, the provider manual, and other notices or directives issued by the department. The provider shall create and maintain documents to substantiate that all requirements are met. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act. HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 38:364 (February 2012), amended by the Department of Health and Hospitals, Bureau of Health Services Financing and the Office of Behavioral Health, LR 41:2359 (November 2015), amended by the Department of Health, Bureau of Health Services Financing and the Office of Behavioral Health, LR 44:1893 (October 2018), LR 46:794 (June 2020), repromulgated LR 46:951 (July 2020). Chapter 27.Reimbursement §2701.General Provisions A.For recipients enrolled with one of the managed care organizations (MCOs) or coordinated system of care (CSoC) contractor, the department or its fiscal intermediary shall make monthly capitation payments to the MCOs or the CSoC contractor. 1.The capitation rates paid to MCOs or the CSoC contractor shall be actuarially sound rates. 2.The MCOs or the CSoC contractor will determine the rates paid to its contracted providers. a.No payment shall be less than the minimum Medicaid rate. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act. HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 38:365 (February 2012), amended by the Department of Health and Hospitals, Bureau of Health Services Financing and the Office of Behavioral Health, LR 39:317 (February 2013), LR 41:2359 (November 2015), amended by the Department of Health, Bureau of Health Services Financing and the Office of Behavioral Health, LR 44:1893 (October 2018), LR 46:794 (June 2020), repromulgated LR 46:951 (July 2020). §2703.Reimbursement Methodology A.Effective for dates of service on or after July 1, 2012, the reimbursement rates for the following behavioral health services provided to children/adolescents shall be reduced by 1.44 percent of the rates in effect on June 30, 2012: 1.therapeutic services; 2.rehabilitation services; and 3.crisis intervention services. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act. HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing and the Office of Behavioral Health, LR 41:2359 (November 2015).