La. Admin. Code tit. 50 § I-701

Current through Register Vol. 50, No. 11, November 20, 2024

Section I-701 - Out-of-State Medical Care

A. Medical claims for out-of-state services are honored when:

1. medical services are needed because of a medical emergency;

2. medical services are needed and the beneficiarys health would be in danger if the beneficiary were required to travel to the beneficiarys state of residence;

3. the state determines, on the basis of medical advice, that the needed medical services, or necessary supplementary resources, are more readily available in the other state; or

4. it is general practice for beneficiaries in a particular locality to use medical resources in another state.

B. Prior authorization is required for out-of-state non-emergency care.

1. - 4. Repealed.

La. Admin. Code tit. 50, § I-701

Promulgated by the Department of Health and Human Resources, LR 5:24 (February 1979), amended LR 6:491 (August 1980), amended by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 2:847 (May 2006), Amended by the Department of Health, Bureau of Health Services Financing, LR 461393 (10/1/2020).

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.