La. Admin. Code tit. 40 § I-5109

Current through Register Vol. 50, No. 9, September 20, 2024

Section I-5109 - Prior Authorization

A. The Louisiana Workers' Compensation Statutes (R.S. 23:1142) establishes a monetary limit for nonemergency medical care. The statute further provides significant penalties for a carrier/self-insured employer's arbitrary and capricious refusal to approve necessary care beyond that limit. (See Chapter 27 Utilization Review Procedu§2715. A and B). In addition to all other rules and procedures, the provider or practitioner who provide care under the "medical emergency" exception must demonstrate that it was a "medical emergency" as outlined in the Utilization Review Procedures, cited above. For additional instructions, please refer to the respective section of the schedule.

La. Admin. Code tit. 40, § I-5109

Promulgated by the Department of Labor, Office of Workers' Compensation, LR 19:54 (January 1993), repromulgated LR 19:212 (February 1993), amended LR 20:1299 (November 1994).

In addition, the following Sections of this Chapter are applicable and shall be used for the other chapters in this Part governing reimbursement. These specific Chapters are: Chapter 31, Vision Care Services; Chapter 33, Hearing Aid Equipment and Services; Chapter 35, Nursing Attendant Care and Home Health Services; Chapter 39, Medical Transportation; Chapter 41, Durable Medical Equipment and Supplies; Chapter 43, Prosthetic and Orthopedic Equipment; Chapter 45, Respiratory Services; Chapter 47, Miscellaneous Claimant Expenses; and Chapter 49, Vocational Rehabilitation Consultant.

AUTHORITY NOTE: Promulgated in accordance with R.S. 23:1034.2.