La. Admin. Code tit. 48 § V-5511

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

Section V-5511 - Requests for Out of State Hospitalization

A. CSHS does not pay for services provided outside of Louisiana except for cases of extraordinary need. Requests for out of state services must be approved by the CSHS Administrative Unit and will be considered only under the following circumstances:

1. the service is not available in Louisiana, and

2. the patient's condition is such that it can not be treated adequately by any other means available in Louisiana; and

3. the patient's condition is of such a serious nature that treatment is justified; and

4. the service is requested by a CSHS attending physician; and

5. No other funding source is available for the requested service.

B. The request must be made in writing, initiated by a CSHS attending physician and supported by a second CSHS attending physician. Circumstances 1-3 must be verified in writing by both physicians. CSHS Regional Office Staff of the patient's region of residence must forward this documentation to the CSHS Central Office along with copies of the following:

1. evidence of CSHS eligibility

2. evidence that there is no other funding source available

3. medical records

4. written documentation of the arrangements made for the requested service with the out-of-state hospital, physician(s), laboratory(ies), and any other vendors who will be submitting bills to CSHS, and

5. transportation and related expenses.

B. A decision will be made on a case by case basis by the CSHS Administrative Unit depending on availability of funds. The CSHS Regional Office of the patient's region of residence will be notified in writing of the disposition of the request. CSHS will reimburse all vendors at the Medicaid rate of the State in which the service is provided. It is the responsibility of the CSHS Regional Staff to obtain this rate and acceptance by the out-of-state providers.

La. Admin. Code tit. 48, § V-5511

Promulgated by the Department of Health and Human Resources, Office of Preventive and Public Health Services, L.R.13.246 (April 1987).1987), amended by the Department of Health and Hospitals, Office of Public Health, LR 22:362 (May 1996).

AUTHORITY NOTE: Promulgated in accordance with R.S. 40:31.2, and R.S. 40:1299.111-120.