PERSONAL CARE SERVICES PROVIDER MANUAL
PERSONAL CARE SERVICES PROVIDER MANUAL
Chapter Thirty of the Medicaid Services Manual
Issued November 1, 2009
Claims/authorizations for dates of service on or after October 1, 2015 must use the applicable ICD-10 diagnosis code that reflects the policy intent. References in this manual to ICD-9 diagnosis codes only apply to claims/authorizations with dates of service prior to October 1, 2015.
State of Louisiana Bureau of Health Services Financing
LOUISIANA MEDICAID PROGRAM
CHAPTER 30: PERSONAL CARE SERVICES SECTION: TABLE OF CONTENTS
ISSUED: REPLACED:
03/04/20 05/22/19
PAGE(S) 4
PERSONAL CARE SERVICES
TABLE OF CONTENTS
SUBJECT
LONG TERM ? PERSONAL CARE SERVICES
OVERVIEW
COVERED SERVICES Service Definitions Service Limitations Service Exclusions LT-PCS and Hospice Shared LT-PCS
RECIPIENT REQUIREMENTS
SECTION
SECTION 30.1 SECTION 30.2
SECTION 30.3
RECIPIENT RIGHTS AND RESPONSIBILITIES Rights and Responsibilities Form Freedom of Choice of Providers Changing Providers Adequacy of Care Participation in Care Voluntary Participation Quality of Care Civil Rights Notification of Changes Grievances/Complaints Fair Hearings
SERVICE ACCESS AND AUTHORIZATION Provider Selection Prior Authorization Post Authorization Changing Providers
SECTION 30.4 SECTION 30.5
Page 1 of 4
Table of Contents
LOUISIANA MEDICAID PROGRAM
CHAPTER 30: PERSONAL CARE SERVICES SECTION: TABLE OF CONTENTS
ISSUED: REPLACED:
03/04/20 05/22/19
PAGE(S) 4
Prior Authorization for New Providers
PROVIDER REQUIREMENTS Licensure and Specific Provider Requirements Provider Responsibilities Back-Up Staffing Plan Emergency Plan Worker Qualifications Changes
SECTION 30.6
SERVICE DELIVERY Plan of Care/Plan of Care Revisions Location of Service Interruption of Services Discontinuation of Services
SECTION 30.7
RECORD KEEPING
SECTION 30.8
Components of Record Keeping
Retention of Records
Confidentiality and Protection of Records
Review by State and Federal Agencies
Recipient Records
Records at the Recipient's Home
Organization of Records, Record Entries and Corrections
Service Logs
Transfers and Closures
INCIDENTS, ACCIDENTS AND COMPLAINTS Incident/Accident Reports Imminent Danger and Serious Harm Internal Complaint Policy
REIMBURSEMENT Span Date Billing
FRAUD AND ABUSE General Fraud
SECTION 30.9
SECTION 30.10 SECTION 30.11
Page 2 of 4
Table of Contents
LOUISIANA MEDICAID PROGRAM
CHAPTER 30: PERSONAL CARE SERVICES SECTION: TABLE OF CONTENTS
ISSUED: REPLACED:
03/04/20 05/22/19
PAGE(S) 4
Provider Fraud Recipient Fraud
PROGRAM OVERSIGHT AND REVIEW Health Standards Section Surveys On-Site Reviews Personnel Record Review Interviews Recipient Record Review Report of Survey Findings Corrective Action Report Informal Dispute Resolution (IDR)
EPSDT-PCS
EPSDT-PCS OVERVIEW
EPSDT-PCS COVERED SERVICE Service Definitions Location of Service Service Limitations Excluded Services
EPSDT-PCS RECIPIENT CRITERIA
EPSDT-PCS RIGHTS AND RESPONSIBILITIES
EPSDT-PCS PRIOR AUTHORIZATION Initial and Subsequent Prior Authorization Requests Chronic Needs Case Plan of Care Changes in Plan of Care Subsequent Plans of Care Reconsideration Requests Changing PCS Providers Prior Authorization Liaison
EPSDT-PCS PROVIDER REQUIREMENTS Standards of Participation
SECTION 30.12
SECTION 30.13 SECTION 30.14 SECTION 30.15 SECTION 30.16 SECTION 30.17
SECTION 30.18
Page 3 of 4
Table of Contents
LOUISIANA MEDICAID PROGRAM
CHAPTER 30: PERSONAL CARE SERVICES SECTION: TABLE OF CONTENTS
ISSUED: REPLACED:
03/04/20 05/22/19
PAGE(S) 4
Electronic Visit Verification Staffing EPSDT-PCS SERVICE DELIVERY EPSDT-PCS RECORD KEEPING Beneficiary Records Availability of Records EPSDT-PCS REIMBURSEMENT LT-PCS FORMS AND LINKS LT-PCS CONTACT INFORMATION BILLING CODES RESERVED RESERVED RESERVED GLOSSARY EPSDT-PCS CONTACT INFORMATION EPSDT-PCS FORMS CLAIMS RELATED INFORMATION
SECTION 30.19 SECTION 30.20
SECTION 30.21 APPENDIX A APPENDIX B APPENDIX C APPENDIX D APPENDIX E APPENDIX F APPENDIX G APPENDIX H APPENDIX I APPENDIX J
Page 4 of 4
Table of Contents
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related download
- state of louisiana
- 2013 dsw resource center summer webinar series white paper
- medication administration faq a guidelines for the
- personal care services provider manual
- coverage of direct service workforce training within
- abuse training for direct support workers topic 1
- louisiana direct service worker
- direct service worker laddc
- section 30 6 lt pcs provider requirements