La. Admin. Code tit. 50 § V-5117

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

Section V-5117 - Service Limits

A. Outpatient hospital services shall be limited to the following:

1. rehabilitation services-number of visits in accordance with a rehabilitation plan prior authorized by the department or its designee;

2. clinic services-physician services provided in a clinic in an outpatient hospital setting shall be considered physician services, not outpatient services, and there shall be no limits placed on the number of physician visits payable by the Medicaid program for eligible recipients; and

3. all other outpatient services, including therapeutic and diagnostic radiology services, shall have no limit imposed other than the medical necessity for the services.

B. There shall be no limits placed on emergency room visits.

La. Admin. Code tit. 50, § V-5117

Adopted by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 402261 (11/1/2014), Amended by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 412643 (12/1/2015).

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