MedicaidCoverageMedium impact
Crisis Stabilization for Children and Adolescents - MEDICAID - LOUISIANA (New)
Humana·LA · Psychiatry, Pediatrics·Medicaid
Effective date
Jan 1, 2023
We identified it
Jun 25, 2026
Summary
Humana updated its Louisiana Medicaid Crisis Stabilization policy for children and adolescents, effective 01/01/2023 with recent language updates on 01/15/2025 for provisionally licensed LMHPs and final LDH approval on 03/31/2025. Billing teams must ensure claims do NOT include room and board costs (only other funding sources reimburse these), recognize that crisis stabilization cannot be billed simultaneously with respite care, and verify member eligibility through Humana Healthy Horizons Louisiana. The policy defines covered services as short-term intensive out-of-home stabilization with family contact, assessment, and consultation—excluding institutional mental disease settings.
Action Required
By 04/15/2025: Billing team must implement the following for all Louisiana Medicaid crisis stabilization claims: (1) Remove any room and board charges from billing submissions—ensure billing system flags and rejects room and board line items before claim submission; (2) Add edit rule to prevent simultaneous billing of crisis stabilization with short-term respite care services on the same date(s); (3) Verify all members are enrolled in Humana Healthy Horizons Louisiana before processing claims; (4) Train billing staff that only service delivery costs are Medicaid-billable; room and board must be pursued through DCFS, OJJ, or family/responsible party; (5) Update encounter forms or internal notes to document that provisionally licensed practitioners (PLPCs, PLMFTs, LMSWs) are now recognized as qualified providers per the 01/15/2025 update. Failure to exclude room and board will result in claim denials and potential recovery actions.