MedicaidDocumentationMedium impact
Community Psychiatric Support and Treatment (CPST) and Psychosocial Rehabilitation (PSR) - MEDICAID - LOUISIANA (New)
Humana·LA · Psychiatry, Pediatrics·Medicaid
Effective date
Jan 1, 2023
We identified it
Jun 25, 2026
Summary
This is an annual review of Humana's Louisiana Medicaid policy for Community Psychiatric Support and Treatment (CPST) and Psychosocial Rehabilitation (PSR) services with no substantive changes to coverage criteria or billing requirements. The policy clarifies medical necessity standards, assessment tools (LOCUS for adults, CALOCUS for children), and prior authorization documentation requirements for mental health rehabilitation services.
Action Required
By January 1, 2024 (or immediately if not yet implemented): Billing and authorization team must ensure all prior authorization requests for CPST/PSR services include: (1) LOCUS assessment (scored ≥3) for adults aged 19+ performed within last 180 days, or CALOCUS for children aged 6-18 performed within last 180 days; (2) Documentation of diagnosable mental disorder with evidence of functional impairment in basic daily living, instrumental living, or participation in family/school/workplace; (3) LMHP or physician recommendation and individualized treatment plan; (4) For child/adolescent cases, documentation of family/guardian communication and coordination with other child-serving systems. Update EMR templates and prior authorization forms to require these specific assessment tools and documentation elements. Configure billing system to flag claims missing LOCUS/CALOCUS scores for denial prevention. Train billing staff that adult members with LOCUS scores of 2 or lower may continue services only if previously qualified and deemed medically necessary for maintenance. Inform providers that members cannot receive MHR services from more than one provider simultaneously unless enrolled in Permanent Supportive Housing program or receiving Behavioral Health Medical Director approval.