Medicaid Benefits: Online Database

Customize Your Search

Show year(s):

2008
2006
2004
2003

Show data by category:

All Categories

Acute Care Services

Institutional and Clinic Services

Practitioner Services

Prescription Drugs

Physical Therapy and Other Services

Products and Devices

Transportation Services

Other Services

Long-Term Care Services

Community Based Care

Institutional Care

Switch to another state...

Benefits by State: Louisiana (October 2008) Notes

Acute Care Services

Is the Benefit Covered?	Copayment Requirement	Prior Approval Requirement	Coverage Limitations	Reimbursement Methodology	Populations Covered

Institutional and Clinic Services
Clinic Services, by an organized facility or clinic not part of a hospital: Freestanding Ambulatory Surgery Center
Yes				Fee for service, using an all-inclusive payment per episode of care	CN & MN
Clinic Services, by an organized facility or clinic not part of a hospital: Public Health and Mental Health Clinics
Yes			Substance abuse treatment not covered	Prospective all-inclusive rate per encounter	CN & MN
Federally Qualified Health Center Services
Yes			15 visits/year, visits count toward physician visit limit where applicable	Prospective all-inclusive rate/encounter	CN & MN
Inpatient Hospital Services, other than in an Institution for Mental Diseases
Yes		Non-emergency admissions	LOS in specified hospitals limited by state's Utilization Review authority	Prospective per diem using peer groups, higher per diem for high intensity services	CN & MN
Outpatient Hospital Services
Yes			3 ER visits/year and count against physician visit limit, no limit for CommunityCare enrollees	Cost based payment or fee for service	CN & MN
Rehabilitation Services: Mental Health and Substance Abuse
Yes		Yes	Substance abuse treatment not covered	Fee for service, some services paid monthly rate	CN & MN
Rural Health Clinic Services
Yes			12 visits/year, visits count toward physician visit limit	Prospective all-inclusive rate/encounter	CN & MN
Practitioner Services
Certified Registered Nurse Anesthetist Services
Yes				Fee for service	CN & MN
Chiropractor Services
No
Dental Services
Yes		Specified services	Exams and x-rays only covered in conjunction with denture construction; pregnant women may also receive specified preventive, restorative and periodontal services	Fee for service	CN & MN - See state-specific FN
Medical and Remedial Care - Other Practitioners

Medical/Surgical Services of a Dentist
Yes		Services provided on an inpatient hospital basis	Services limited to what a physician would provide and are included in physician 12 visit/year limit unless provided on an inpatient hospital basis	Fee for service	CN & MN
Nurse Midwife Services
Yes				Fee for service	CN & MN
Nurse Practitioner Services
Yes			12 ambulatory visits/year irrespective of setting, 1 inpatient hospital visit/day	Fee for service at 80% of physician fee with some exceptions	CN & MN
Optometrist Services
Yes			Limited to diagnosis and treatment of medical eye problems as permitted by law,12 visits/year included in physician visit limit	Fee for service	CN & MN
Physician Services
Yes		Specified surgical procedures including those to be performed on inpatient basis that are normally rendered on outpatient basis	12 ambulatory visits/year irrespective of setting, 1 preventive care visit/.year, 1 inpatient hospital visit/day	Fee for service	CN & MN
Podiatrist Services
Yes		Specified surgical procedures	12 visits/year,1 inpatient hospital visit/day, specified services not covered	Fee for service	CN & MN
Psychologist Services
No
Prescription Drugs
Prescription Drugs
Yes	$.50-$3/Rx depending on drug cost	Specified drugs	8 Rxs/month	AWP-13.5% for independent pharmacies, AWP-15% for chain stores, plus $5.77 dispensing fee for each	CN & MN
Physical Therapy and Other Services
Occupational Therapy Services
No
Physical Therapy Services
No
Services for Speech, Hearing and Language Disorders
Yes		Yes	Physician referral required for specified services	Fee for service	CN & MN
Products and Devices
Dentures
Yes		All services other than repairs	1 full upper and lower denture and 1 reline/7years, or 2 relines on existing denture/7 years, partial lower denture only allowed to balance occlusion with full upper denture, repairs covered only if denture would then be fully serviceable	Fee for service	CN & MN - See state-specific FN
Eyeglasses
No
Hearing Aids
No
Medical Equipment and Supplies
Yes		Yes		Fee for service, some items individually priced	CN & MN
Prosthetic and Orthotic Devices
Yes		Yes		Fee for service	CN & MN
Transportation Services
Ambulance Services
Yes				Fee for service, using Medicare payment ceilings	CN & MN
Non-Emergency Medical Transportation Services
Yes		Yes		See service-specific FN	CN & MN
Other Services
Diagnostic, Screening and Preventive Services
Yes			Limited to specified screening services, including mammography	Fee for service	CN & MN
Early and Periodic Screening, Diagnosis and Treatment
See service-specific FN.
Extended Services for Pregnant Women

Family Planning Services
See service-specific FN.
Laboratory and X-Ray Services, outside Hospital or Clinic
Yes				Fee for service	CN & MN
Targeted Case Management
Yes				Fee for service or monthly rate	CN & MN

Long-Term Care Services


Community Based Care
Home and Community Based Services Waiver
Yes		Services for the following populations: 2, 4 & 8 - See service-specific FN	Dependent upon the services provided	CN & MN
Home Health Services, includes nursing services, home health aides, and medical supplies/equipment
Yes	Therapy services, med equipment and supplies	50 nursing and home health aide visits/year	Prospective rates	CN & MN
Hospice Care
Yes		Two 90-day periods with additional 60-day periods as necessary	Prospective rates based on Medicare methodology	CN & MN
Personal Care Services
Yes	Yes	Medical criteria for nursing facility placement must be met, 56 hours/week	Fee for service	CN & MN
Private Duty Nursing Services
No
Program of All-Inclusive Care for the Elderly
Yes	See service-specific FN		Capitated payment	CN
Institutional Care
Inpatient Hospital, Nursing Facility and Intermediate Care Facility Services In Institutions for Mental Diseases, age 65 and older
Yes	Admission and LOS certification	Limited to inpatient hospital settings	Prospective cost based per diem	CN & MN
Inpatient Psychiatric Services, under age 21
Yes	Admission and LOS certification		Prospective cost based per diem	CN & MN
Intermediate Care Facility Services for the Mentally Retarded
Yes	For LOC determination upon admission	7 hosp leave days/hospitalization, 30 consecutive therapeutic leave days up to 45/year	Private facilities paid standard per diem with LOC and facility size adjustors, public facilities paid cost based per diem up to Medicare upper limit	CN & MN
Nursing Facility Services, other than in an Institution for Mental Diseases
Yes	For LOC determination upon admission	7 hosp leave days/hospitalization, 15 therapeutic leave days/year	Private facilities paid prospective acuity adjusted per diem, cost based per diem up to Medicare limits for public facilities	CN & MN
Religious Non-Medical Health Care Institution and Practitioner Services
No

Notes: Adult dental services are generally limited to the CN population and to denture-related services, however pregnant women irrespective of eligibility category may receive specified preventive, restorative and periodontal services as well as denture-related services. This State has added the optional Medicaid buy-in group of disabled adults permissible through the Ticket to Work and Work Incentives Improvement Act (TWWIIA). These beneficiaries are allowed to continue Medicaid coverage, and receive full benefits, if their income is at or below 250 percent of the federal poverty level (FPL). Beneficiaries in this group with income above 150 percent of the FPL pay an income-based monthly premium.