La. Admin. Code tit. 50 § XXXIII-7103

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

Section XXXIII-7103 - Recipient Qualifications

A. The targeted population for the 1915(b)(3) services shall be Medicaid recipients who:

1. are at least 21 years of age;

2. have a qualifying mental health diagnosis;

3. meet medical necessity in accordance with LAC 50:I.1101; and

4. have transitioned from a nursing facility or been diverted from nursing facility level of care.

B. Recipients of personal care services (PCS) must meet the following additional recipient eligibility criteria:

1. recipients must be medically stable;

2. recipients shall not be enrolled in a Medicaid-funded program which offers a personal care service or related benefit; and

3. recipients' care needs do not exceed that which can be provided under the scope and/or service limitations of PCS.

C. An adult with a diagnosis of a substance use disorder or intellectual and developmental disability without an additional co-occurring qualifying mental health diagnosis shall not meet the criteria for mental health services.

La. Admin. Code tit. 50, § XXXIII-7103

Promulgated by the Department of Health, Bureau of Health Services Financing and the Office of Behavioral Health, LR 471874 (12/1/2021).

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