NEW OPPORTUNITIES WAIVER (NOW) PROVIDER MANUAL
NEW OPPORTUNITIES WAIVER (NOW)
PROVIDER MANUAL
Chapter Thirty-two of the Medicaid Services Manual
Issued March 1, 2011
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
ISSUED:
REPLACED:
CHAPTER 32: NEW OPPORTUNITIES WAIVER
TABLE OF CONTENTS
04/10/23 04/01/14
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SUBJECT
NEW OPPORTUNTIES WAIVER TABLE OF CONTENTS
SECTIONS
OVERVIEW
32.0
COVERED SERVICES
32.1
Individual and Family Support Individual and Family Support ? Day Individual and Family Support ? Night Shared Supports Sharing Supports among Roommates Sharing Supports among Non-Roommates Transportation Place of Service Standards Service Exclusions Service Limitations Authorization for Worker to Exceed 16-Hour Service Limitation Reimbursement
Center-Based Respite Transportation Standards Service Exclusions Service Limitations Reimbursement
Community Integration Development Shared Supports Transportation Standards Service Limitations Reimbursement
Residential Habilitation ? Supported Independent Living Place of Service Standards Service Exclusions Service Limitations
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Table of Contents
LOUISIANA MEDICAID PROGRAM
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Reimbursement Substitute Family Care
Standards Service Exclusions Service Limitations Reimbursement Day Habilitation Transportation Place of Service Standards Service Limitations Supported Employment Types of Supported Employment Services
Individual Placement or One-to-One Model Follow Along Mobile Work Crew/Enclave Transportation Place of Service Standards Service Exclusions Service Limitations Reimbursement Employment-Related Training Transportation Standards Service Exclusions Service Limitations Reimbursement Environmental Accessibility Adaptations Standards Service Exclusions Service Limitations Authorization to Exceed Cap Reimbursement Specialized Medical Equipment and Supplies Standards Service Exclusions Service Limitations Authorization to Exceed Cap Personal Emergency Response Systems Standards Service Limitations
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LOUISIANA MEDICAID PROGRAM
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CHAPTER 32: NEW OPPORTUNITIES WAIVER
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Reimbursement Professional Services
Psychological Services Social Work Services Nutritional/Dietary Services Standards Service Exclusions Service Limitations Reimbursement Skilled Nursing Shared Supports Standards Service Exclusions Service Limitations
Authorization to Exceed 12-Hour Skilled Nursing Service Cap Reimbursement One Time Transitional Expenses Standards Service Exclusions Service Limitations Housing Stabilization Transition Service and Housing Stabilization Service Housing Stabilization Transition Service Housing Stabilization Service Standards Service Exclusions Service Limitations Reimbursement
SELF-DIRECTION OPTION
32.2
BENEFICIARY REQUIREMENTS
32.3
Request for Services Registry Inactive Status Verifying Request Date
Level of Care Discharge Criteria
RIGHTS AND RESPONSIBILITIES
32.4
Freedom of Choice of Program Notification of Changes
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LOUISIANA MEDICAID PROGRAM
ISSUED:
REPLACED:
CHAPTER 32: NEW OPPORTUNITIES WAIVER
TABLE OF CONTENTS
04/10/23 04/01/14
PAGE(S) 7
Participation in Care Freedom of Choice of Support Coordination and Service Providers Voluntary Participation Compliance with Civil Rights Quality of Care Grievances/Fair Hearings Rights and Responsibilities Form
SERVICE ACCESS AND AUTHORIZATION
32.5
Provider Selection Prior Authorization Post Authorization One Time Transitional Expenses Changes
Changing Direct Service Providers Prior Authorization for New Service Providers
Changing Supported Independent Living Providers Changing Support Coordination Agencies
PROVIDER REQUIREMENTS
32.6
Other Provider Responsibilities Support Coordination Providers Direct Service Provider Responsibilities
Individualized Service Plan Back-up Planning Emergency Evacuation Planning Residential Habilitation ? Supported Independent Living Provider Responsibilities Day Habilitation Provider Responsibilities Supported Employment Provider Responsibilities Employment Related Training Provider Responsibilities Professional Services ? Psychological Provider Responsibilities Skilled Nursing Services Provider Responsibilities
STAFFING REQUIREMENTS
32.7
Individualized and Family Support Residential Habilitation ? Supported Independent Living Substitute Family Care
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