La. Admin. Code tit. 50, § XXXIII-101 - General Provisions
A. The
Medicaid Program hereby adopts provisions to establish a comprehensive system
of delivery for specialized behavioral health and physical health services.
These services shall be administered through the Healthy Louisiana and
Coordinated System of Care (CSoC) Waiver 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.
B. The provisions of this Rule shall apply
only to the services provided to Medicaid recipients/enrollees by or through an
MCO or the CSoC contractor.
C.
Managed care organizations shall operate as such, and the CSoC contractor shall
operate as a prepaid inpatient health plan (PIHP). The MCOs and the CSoC
contractor were procured through a competitive request for proposal (RFP)
process. The MCOs and CSoC contractor shall assist with the states system
reform goals to support individuals with behavioral health and physical health
needs in families homes, communities, schools and jobs.
D. Through the utilization of MCOs and the
CSoC contractor, it is the departments goal to:
1. increase access to a broad array of
evidence-based home and community-based services that promote hope, recovery
and resilience;
2. improve quality
by establishing and measuring outcomes;
3. manage costs through effective utilization
of State, federal, and local resources; and
4. foster reliance on natural supports that
sustain individuals and families in homes and communities.
E. The CSoC contractor shall be paid on a
risk basis for specialized behavioral health services rendered to
children/youth enrolled in the Coordinated System of Care Waiver. The MCOs
shall be paid on a risk basis for specialized behavioral health and physical
health services rendered to adults and children/youth.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
A. The Medicaid Program hereby adopts provisions to establish a comprehensive system of delivery for specialized behavioral health and physical health services. These services shall be administered through the Healthy Louisiana and Coordinated System of Care (CSoC) Waiver 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.
B. The provisions of this Rule shall apply only to the services provided to Medicaid recipients/enrollees by or through an MCO or the CSoC contractor.
C. Managed care organizations shall operate as such, and the CSoC contractor shall operate as a prepaid inpatient health plan (PIHP). The MCOs and the CSoC contractor were procured through a competitive request for proposal (RFP) process. The MCOs and CSoC contractor shall assist with the states system reform goals to support individuals with behavioral health and physical health needs in families homes, communities, schools and jobs.
D. Through the utilization of MCOs and the CSoC contractor, it is the departments goal to:
1. increase access to a broad array of evidence-based home and community-based services that promote hope, recovery and resilience;
2. improve quality by establishing and measuring outcomes;
3. manage costs through effective utilization of State, federal, and local resources; and
4. foster reliance on natural supports that sustain individuals and families in homes and communities.
E. The CSoC contractor shall be paid on a risk basis for specialized behavioral health services rendered to children/youth enrolled in the Coordinated System of Care Waiver. The MCOs shall be paid on a risk basis for specialized behavioral health and physical health services rendered to adults and children/youth.