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Crisis Stabilization for Adults - MEDICAID - LOUISIANA (Revised)
Effective date
Aug 26, 2026
Identified
Aug 25, 2026
Summary
This is a revised Louisiana Medicaid policy for Crisis Stabilization (CS) services for adults, effective 08/26/2026. The policy establishes coverage criteria, assessment requirements, intervention standards, and care coordination protocols for short-term bed-based crisis mental health treatment. Key billing requirement: Concurrent review is mandatory after the initial 24-hour period, and claims may be subject to recoupment if documentation does not support medical necessity of the crisis.
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What to do
Action · 6 steps
01Billing team must establish concurrent review workflow in billing system to trigger mandatory reviews after 24-hour admission period for all CS claims.
02Update claim submission requirements to demand documentation showing relief, resolution, and problem-solving of identified crisis or referral to alternate provider—claims lacking this documentation will be denied and subject to recoupment.
03Create internal checklist verifying member age (≥21 years), medical stability, LMHP/psychiatrist recommendation, and appropriate referral source (MCR, BHCC, CBCS, or ACT teams) before billing.
04Train billing and provider teams that immediate notification to Humana Healthy Horizons Louisiana must occur upon member admission.
05Implement system rules to flag claims for retrospective review and potential recoupment if clinical documentation does not support crisis justification.
06Ensure all encounters include psychiatric diagnostic evaluation (unless completed within 30 days with current status update) and medical screening by RN/LPN to confirm stability.
If missed: Failure to obtain concurrent review approvals and submit required documentation will result in claim denials and recoupment of paid amounts.
Original notice
Crisis Stabilization for Adults - MEDICAID - LOUISIANA (Revised)
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