PHARMACY PROVIDERS, PLEASE
If you are unsure about the coverage
of a drug product, please contact the PBM help desk at 1-800-648-0790.
Please file adjustments for claims
that may have been incorrectly paid. Only those products of the manufacturers
which participate in the Federal Rebate Program will be covered by the Medicaid
program. Participation may be verified in Appendix C, available at
Should you have any questions
regarding any of the following messages, please contact Molina Medicaid
Solutions at (800) 473-2783 or (225) 924-5040.
For information regarding the medication policy and/or criteria associated with this denial, providers
may access the Louisiana Medicaid Preferred Drug List (PDL) / Non-Preferred Drug List at
CHANGES TO DURABLE MEDICAL EQUIPMENT, HOME HEALTH, PEDIATRIC DAY HEALTH CARE, REHABILITATION AND PERSONAL CARE SERVICES, PHARMACY AND OTHER SERVICES REQUIRING PRIOR AUTHORIZATION DUE TO HURRICANE IDA – August 2021
On August 26, 2021, Governor John Bel Edwards declared a state of emergency ahead of Hurricane Ida as significant impact to the state of Louisiana was expected. The policy changes included in this bulletin are effective August 27, 2021 and shall only be applicable for the following Parishes: Ascension, Assumption, East Baton Rouge, East Feliciana, Iberia, Iberville, Jefferson, Lafourche, Livingston, Orleans, Plaquemines, Pointe Coupee, St. Bernard, St. Charles, St. Helena, St. James, St. John the Baptist, St.
Martin, St. Mary, St. Tammany, Tangipahoa, Terrebonne, Washington, West Baton Rouge and West Feliciana.
Medicaid beneficiaries who live in one of the parishes under mandatory evacuation, and who are in need of replacement equipment or supplies previously approved by Medicaid, may contact a Medicaid-enrolled durable medical equipment (DME) provider of their choice. Medicaid-enrolled providers must make a request to Gainwell Technologies’ Prior Authorization Unit; however, a new prescription and medical documentation are not required. The provider shall submit the required Prior Authorization Form (PA-01) along with a signed letter from the recipient, giving a current place of residence and stating that the original equipment or supplies were lost due to Hurricane Ida.
Beneficiaries who were approved to receive medical equipment, supplies, home health services, rehabilitation, pediatric day health care or personal care services from a provider that is no longer in business or unable to provide the approved equipment, supplies or services may obtain the approved items or services from a new provider of their choice.
The provider must be enrolled in Medicaid. Gainwell Technologies shall provide any guidance to the provider on the cancelation of the original authorization and issuance of a new authorization, if applicable.
All existing prior authorizations for the services listed below should be extended through October 31, 2021:
- Any necessary medical and surgical procedures
- Applied Behavior Analysis (ABA)
- Assertive Community Treatment (ACT)
- Community Psychiatric Support and Treatment (CPST)
- EPSDT personal care services (PCS)
- Functional Family Therapy – Child Welfare (FFT-CW)
- Functional Family Therapy (FFT)
- Home Health Services (EHH)
- Hospice Services
- Multi-Systemic Therapy (MST)
- Pediatric Day Health Care
- Permanent Supportive Housing (PSH)
- Pharmacy (for non- controlled, non-specialty drugs)
- Psychiatric Outpatient by Licensed Mental Health Professionals (LMHPs)
- Psychosocial Rehabilitation (PSR)
- Substance Use Outpatient and Intensive Outpatient
- Therapies (PT/OT/SLT)
Questions concerning Healthy Louisiana managed care organization processes are to be directed to the appropriate MCO. Those questions related to Medicaid fee-for-service claims should be directed to Gainwell Technologies Provider Relations at (800) 473-2783 or (225) 924-5040.