Assertive Community Treatment (ACT/FACT) - MEDICAID - LOUISIANA (New)

By June 26, 2023 (30 days from issue): 1) Billing and clinical teams must implement mandatory prior authorization process for all ACT/FACT service requests submitted to Louisiana Medicaid. 2) Update billing system to flag ACT service claims requiring prior auth documentation before submission. 3) Providers must document that patients meet ALL of the following before billing: (a) Age 18+, (b) One qualifying diagnosis (schizophrenia, psychotic disorder, bipolar disorder, or major depressive disorder), (c) One service need from the defined list (e.g., 2+ psychiatric hospitalizations in 6 months, 2+ law enforcement interactions in past year, current inpatient status, or forensic/probation criteria), (d) One ability barrier (inability to engage traditional services, inability to meet basic needs/homelessness, or forensic diversion necessity), and (e) Three of nine risk/complexity factors. 4) Create intake screening checklist in EMR documenting all eligibility criteria. 5) Train front-desk and billing staff on exception criteria for patients discharging from institutions or frequent ED users. 6) Establish documentation protocol to capture comprehensive 30-day admission assessment required by policy. Failure to obtain prior authorization or submit incomplete medical necessity documentation will result in claim denials.