PHARMACY PROVIDERS PLEASE NOTE!!!

DETAILED FUL CHANGES ARE POSTED ON WWW.LAMEDICAID.COM.

IF YOU ARE UNSURE ABOUT THE COVERAGE OF A DRUG PRODUCT, PLEASE CONTACT THE PBM HELP DESK AT 1-800-648-0790.                                  

PLEASE FILE ADJUSTMENTS FOR CLAIMS THAT MAY HAVE BEEN INCORRECTLY PAID.

ONLY THOSE PRODUCTS OF THE MANUFACTURERS WHICH PARTICIPATE IN THE FEDERAL REBATE PROGRAM WILL BE COVERED BY THE MEDICAID PROGRAM. PARTICIPATION MAY BE VERIFIED IN APPENDIX C, AVAILABLE AT WWW.LAMEDICAID.COM.

IMPORTANT UPDATE TO PROVIDER NOTICE ISSUED FEBRUARY 28, 2006:

ATTENTION WAIVER SERVICE PROVIDERS, SERVICE PROVIDERS FOR 
LT-PCS AND EPSDT SERVICES AND SUPPORT COORDINATORS

POLICY/PROCEDURES CHANGES ISSUED SEPTEMBER 9, 2005 IN RESPONSE TO 
HURRICANE KATRINA EXPIRED FEBRUARY 28, 2006. THREE OF THE CHANGES HAVE 
BEEN EXTENDED, SUBJECT TO CERTAIN REQUIREMENTS, FOR PROVIDERS STILL 
AFFECTED BY KATRINA, PLEASE REFER TO 
HTTP://WWW.LAMEDICAID.COM/PROVWEB1/KATRINA/WAIVERSERVICES.PDF  FOR POLICY
AND PROCEDURE CLARIFICATION. 

ATTENTION WAIVER SERVICE PROVIDERS AND SUPPORT COORDINATORS

EFFECTIVE JULY 1, 2006, THE DEPARTMENT OF HEALTH AND HOSPITALS (DHH) WILL HAVE TWO CHANGES IN THE EDA WAIVER SERVICE PACKAGE: 1) REMOVAL OF HOUSEHOLD SUPPORTS; AND 2) PERSONAL SUPERVISION (DAY) AND PERSONAL SUPERVISION (NIGHT) WILL BE COMBINED TO ONE SERVICE KNOWN AS COMPANION SERVICE. IF YOU HAVE ANY QUESTIONS, PLEASE CONTACT YOUR DIVISION OF LONG TERM SUPPORTS AND SERVICES (DLTSS) REGIONAL OFFICE STAFF AND/OR SUPPORT COORDINATION AGENCIES. PLEASE REFER TO THE FOLLOWING WEBSITE: HTTP://WWW.LAMEDICAID.COM . 

ATTENTION PROFESSIONAL SERVICES PROVIDERS

THE 2006 HCPCS CODES HAVE BEEN LOADED TO OUR FILES AND MAY BE SUBMITTED FOR DATES OF SERVICE JANUARY 1, 2006 FORWARD. LOOK IN THE UPDATED 2006 FEE SCHEDULE ON THE LOUISIANA MEDICAID WEBSITE, WWW.LAMEDICAID.COM IN THE NEAR FUTURE.

ATTENTION MENTAL HEALTH REHABILITATION PROVIDERS

EFFECTIVE WITH DATES OF SERVICE MAY 1, 2006 THE REIMBURSEMENT RATE FOR ASSESSMENT (PROCEDURE CODE H0031) IS BEING INCREASED TO $206.08. PROVIDERS SHOULD BEGIN BILLING THE INCREASED RATE FOR DATES OF SERVICE MAY 1, 2006 OR LATER.

ATTENTION MENTAL HEALTH REHABILITATION PROVIDERS

EFFECTIVE WITH DATES OF SERVICE JUNE 1, 2006 THE REIMBURSEMENT RATE FOR MEDICATION ASSESSMENT, MONITORING AND EDUCATION (PROCEDURE CODE 90862) IS BEING INCREASED. THE MAXIMUM ALLOWABLE FEE FOR THIS PROCEDURE WILL BE $49.64 WHEN THE SERVICING PROVIDER IS A PSYCHIATRIST, $39.71 WHEN THE SERVICING PROVIDER IS AN APRN AND $33.26 WHEN THE SERVICING PROVIDER IS A RN. PROVIDERS MUST ENTER THE SERVICING PROVIDER'S (PSYCHIATRIST OR APRN ONLY) INDIVIDUAL MEDICAID PROVIDER NUMBER IN ITEM 24 K OF THE CMS 1500 CLAIM FORM. IF ITEM 24 K IS BLANK, PAYMENT WILL BE MADE AT THE RN RATE. 

ATTENTION PHARMACY PROVIDERS

UPDATES TO THE PHARMACY BENEFITS MANAGEMENT SERVICES MANUAL ARE NOW AVAILABLE ON THE LOUISIANA MEDICAID WEBSITE AT WWW.LAMEDICAID.COM. POLICY HAS BEEN UPDATED IN SECTIONS 37.5 - COVERED SERVICES, LIMITATIONS AND EXCLUSIONS; 37.6 - REIMBURSEMENT FOR SERVICES; AND 37.7 - MEDICARE PRESCRIPTION DRUG COVERAGE. PHARMACY PROVIDERS SHOULD REFER TO THE MANUAL FOR A COMPLETE DESCRIPTION OF MEDICAID PHARMACY PROGRAM POLICY. 

ATTENTION NEW OPPORTUNITY WAIVER SERVICES PROVIDERS

DUE TO INFORMATION FROM CMS, BEGINNING JUNE 15, 2006, PROVIDERS OF MEDICAID NEW OPPORTUNITY WAIVER SERVICES WILL NO LONGER BE REIMBURSED FOR PROVIDING WAIVER SERVICES TO PARTICIPANTS DURING INPATIENT HOSPITAL DAYS. SEE DHH WEBSITE FOR FURTHER INFORMATION.