MedicaidPrior AuthMedium impact
Multi-Systemic Therapy (MST) - MEDICAID - LOUISIANA (New)
Humana·LA · Psychiatry, Pediatrics·Medicaid
Effective date
Apr 15, 2023
We identified it
Jun 25, 2026
Summary
Humana has updated its Multi-Systemic Therapy (MST) coverage policy for Louisiana Medicaid (Humana Healthy Horizons). The policy, last reviewed on 3/10/2025, establishes medical necessity criteria for MST services for youth ages 12-17 at risk of out-of-home placement. The policy defines initial treatment eligibility, exclusion criteria, continuation requirements, and discharge criteria. Billing teams must ensure all MST service requests include proper prior authorization documentation (psychosocial assessment and case summary/treatment plan) and verify member eligibility against the specified clinical criteria.
Action Required
Before submitting any MST claims for Louisiana Medicaid (Humana Healthy Horizons) members: (1) Billing team must verify that all prior authorization requests for MST include required documentation: psychosocial assessment, case summary/treatment plan, and supporting documentation showing member meets ALL initial criteria (significant externalizing behavior, at-risk for out-of-home placement, DSM-5 diagnosis of Conduct Disorder or equivalent, multiple system involvement, failed less intensive treatment, and CFT recommendation); (2) Update billing system to flag MST claims for prior authorization review; (3) Providers must not submit MST claims for members meeting exclusion criteria (primary suicidal/homicidal/psychotic behavior concerns, independent living youth without identifiable caregiver, sexual offending only, autism spectrum with moderate-severe communication/social deficits, low-level need cases, or prior MST recipients); (4) For continuation of MST beyond initial course, verify treatment shows objective progress, plan updated based on clinical response, family actively engaged, and does not require higher level of care; (5) Claims will be denied if prior authorization not obtained or if documentation does not support medical necessity per policy criteria.