MedicaidCoverageMedium impact
Personal Care Services (PCS) for Adults with Serious Mental Illness (SMI) - MEDICAID - LOUISIANA (New)
Humana·LA · Psychiatry, Family Medicine, Internal Medicine·Medicaid
Effective date
Oct 21, 2024
We identified it
Jun 24, 2026
Summary
New Louisiana Medicaid policy establishes Personal Care Services (PCS) for adults with serious mental illness, allowing up to 20 hours per week of assistance with daily living activities. Services require prior authorization and must be recommended by a licensed mental health professional.
Action Required
Immediately: Billing team must establish prior authorization workflow for PCS for adults with SMI in Louisiana. Verify member eligibility requirements (age 21+, transitioned from nursing facility via My Choice Louisiana program, medically stable). Ensure all prior auth requests include required documentation: service plan with specific activities and frequency, confirmation from Humana DOJ/PASRR Liaison, and supporting medical necessity documentation. Services billed in 15-minute units, maximum 20 hours per week unless approved by medical director.