MedicaidCoverageMedium impact
Hospital Based Care Coordination of Pregnant Members with Substance Use Disorder - In Lieu of Service - MEDICAID - LOUISIANA (New)
Humana·LA · OB-GYN, Psychiatry, Family Medicine·Medicaid
Effective date
Jun 6, 2025
We identified it
Jun 24, 2026
Summary
This is a new Humana Medicaid policy establishing an In Lieu of Service (ILOS) program for hospital-based care coordination of pregnant members with substance use disorder in Louisiana. The policy covers comprehensive pregnancy medical home services for eligible members 18+ who are pregnant or up to 12 months postpartum, with no prior authorization required.
Action Required
Before June 6, 2025: Billing teams serving Louisiana Medicaid pregnant members with substance use disorder should review this new ILOS benefit structure. Verify hospital-based providers meet staffing qualifications (licensed mental health professionals with 1:40 staffing ratio). Update systems to recognize this comprehensive care coordination service does not require prior authorization for eligible members. Note that this ILOS may be subject to clinical claims reviews.