What insurance policy changes affect Louisiana providers?

This page tracks changes from major payers (including Medicaid managed care, commercial insurers, and Medicare Advantage plans) that explicitly apply to Louisiana. Changes include prior authorization updates, billing code additions or deletions, and reimbursement rate revisions.

How often are Louisiana policy changes updated?

Our scrapers run daily and publish new findings within 24 hours of detection. Each change includes an effective date where stated so you can prioritize what requires immediate action.

How do I get alerted to new Louisiana insurance policy changes?

Create a free alert on PolicyChanges.app and filter by state to Louisiana. You will get an email when new matching changes are detected: daily or weekly, your choice, on every plan.

PAYER POLICY CHANGES

Louisiana Insurance & Medicaid Policy Updates

Louisiana providers face a continuous stream of payer policy changes: coverage edits, prior authorization expansions, billing code revisions, and Medicaid reimbursement updates that affect day-to-day practice operations. This page surfaces every tracked policy change that explicitly names Louisiana, so your billing and compliance teams can act before the effective date, not after a claim denial.

Ambetter · Effective Dec 5, 2026High impact
Evolent Musculoskeletal Program Updates Effective 12.5.26
Effective December 5, 2026, Evolent will implement new site-of-care selection requirements for shoulder, hip, knee, and spine surgeries for Ambetter Marketplace members. Providers must select outpatient settings when clinically appropriate; if hospital-based settings are chosen for procedures that can be performed outpatient, providers must document allowable exceptions or provide clinical justification. Clinical reviewers will evaluate both medical necessity and site of care before authorization.
UnitedHealthcare · Effective Jan 1, 2027High impact
New oncology prior authorization code updates
Effective January 1, 2027, UnitedHealthcare is adding prior authorization requirements for 11 HCPCS oncology medication codes when administered in outpatient settings for cancer treatment. These codes include busulfan, leucovorin calcium, luspatercept, dexrazoxane, dinutuximab, octreotide, triptorelin, omidubicel, zoledronic acid, and cyclosporine. This change applies across commercial, Medicare Advantage, Medicaid, and Individual Exchange plans.
Louisiana Medicaid · Effective Jan 1, 2027High impact
LTC Monthly Processing Schedule for Calendar Year 2027
Gainwell has released the 2027 LTC Monthly Processing Schedule establishing specific submission deadlines and payment release dates for Long-Term Care, ICF-DD, and Hospice (Room & Board) claims. Claims submitted via EDI (837I) or UB-04 forms must arrive by noon on scheduled dates to be included in the corresponding month's check write; late submissions will be processed in the next monthly cycle. This policy replaces any prior year scheduling guidance and requires coordination of billing workflows to meet strict cutoff times.
Ambetter · Effective Jan 1, 2027High impact
Ambetter from Louisiana Healthcare Connections Billing Code Update for various HCPC H Codes: Effective 01/01/2027
Effective January 1, 2027, Ambetter from Louisiana Healthcare Connections will discontinue coverage for 45 HCPCS H codes (behavioral health and social services) while adding coverage for H0006. Billing teams must identify affected claims, update system edits, and establish alternative coding or prior authorization protocols before the effective date.
Humana · Effective Nov 1, 2026High impact
Pembrolizumab products (Keytruda, Keytruda Qlex) (New)
Humana Louisiana Medicaid has established a new prior authorization policy for pembrolizumab products (Keytruda IV powder, Keytruda IV solution, Keytruda Qlex subcutaneous) effective November 1, 2026. The policy covers 26 cancer indications with specific clinical criteria, combination therapy requirements, and exclusions (including disease progression on prior anti-PD-1/PD-L1 therapy). All pembrolizumab claims for these indications require prior authorization before the service is rendered or claims will be denied.
Humana · Effective Nov 1, 2026High impact
Enhertu (fam-trastuzumab deruxtecan-nxki) (New)
Humana Louisiana Medicaid has established a new prior authorization pharmacy coverage policy for Enhertu (fam-trastuzumab deruxtecan-nxki) effective November 1, 2026. The policy covers seven HER2-related cancer indications with specific clinical criteria for approval, including early breast cancer, metastatic breast cancer, HER2-low/ultralow breast cancer, gastric adenocarcinoma, HER2-mutant non-small cell lung cancer, and HER2-positive solid tumors. Billing teams must implement prior authorization requirements for all Enhertu claims under Louisiana Medicaid before the effective date.
Humana · Effective Oct 7, 2026High impact
Wheelchair, Wheelchair Repairs, Standing Frame, and Patient Lift - MEDICAID - LOUISIANA (Revised)
Humana Healthy Horizons Louisiana Medicaid revised its coverage policy for wheelchairs, wheelchair repairs, standing frames, and patient lifts effective 2026-10-07. The policy clarifies prior authorization requirements, medical necessity criteria, required documentation (including state-licensed physician and therapist evaluations), and coverage limitations. Only one wheelchair at a time is covered; backup chairs are denied. All wheelchairs and modifications require prior authorization.
Humana · Effective Oct 7, 2026High impact
Applied Behavior Analysis - MEDICAID - LOUISIANA (Revised)
Humana Louisiana Medicaid revised its Applied Behavior Analysis (ABA) coverage policy effective 10/07/2026, establishing a two-step prior authorization process requiring a comprehensive diagnostic evaluation (CDE) by a qualified health care professional before ABA services can be authorized. The policy clarifies QHCP qualifications, CDE requirements, behavior treatment plan documentation, and coordination with IEPs and waiver services for members under 21 with diagnosed behavioral/developmental conditions.
Humana · Effective Oct 7, 2026High impact
Skin and Tissue Substitutes - MEDICAID - LOUISIANA (Revised)
Humana's revised Louisiana Medicaid policy on skin and tissue substitutes covers these products only for partial and full-thickness diabetic lower extremity ulcers that meet a list of criteria, and it requires prior authorization with documentation that every criterion is met. It also limits coverage to 10 treatments in a 12-week period, stops coverage after five applications with no measurable decrease in wound size or depth, and bars using two products at once or hyperbaric oxygen at the same time. The source states an effective date of 10/07/2026, which has already passed, so confirm the policy is still the current version before relying on it.
Humana · Effective Oct 7, 2026High impact
Applied Behavior Analysis - MEDICAID - LOUISIANA (Revised)
This is a NEW Humana Louisiana Medicaid policy (effective 10/07/2026) establishing coverage criteria for skin and tissue substitutes limited to partial and full-thickness diabetic lower extremity ulcers only. All other indications are not covered. Coverage requires prior authorization, comprehensive wound care documentation, specific clinical criteria (ulcer ≥1 cm, ≥4 weeks duration, no measurable healing despite therapy), HbA1c ≤9%, adequate circulation, and is capped at 10 treatments per 12 weeks with a hard stop after 5 applications without improvement.
Humana · Effective Oct 1, 2026High impact
Molecular Biomarkers for Prostate Cancer Risk Stratification - Medicare Advantage (Revised)
This is a comprehensive Medicare Advantage coverage policy for molecular biomarker tests used in prostate cancer risk stratification (effective 10/1/2026). The policy establishes coverage criteria for tests like ArteraAI, EpiSwitch, IsoPSA, MyProstateScore 2.0, ProMark, and ProsTAV, with coverage determinations based on MAC-specific LCDs/LCAs that vary by geographic jurisdiction. Billing teams must identify the correct MAC jurisdiction and apply the corresponding LCD requirements for each test ordered.
Humana · Effective Oct 1, 2026High impact
Imfinzi (durvalumab) (New)
Humana Medicaid (Louisiana) has implemented a new prior authorization policy for Imfinzi (durvalumab) effective October 1, 2026, covering 10 oncologic indications including biliary tract cancer, endometrial cancer, gastric/GE junction adenocarcinoma, hepatocellular carcinoma, non-small cell lung cancer (metastatic, perioperative, unresectable), small cell lung cancer (extensive and limited stage), and bladder cancer. The policy requires specific combination chemotherapy regimens and excludes patients with prior disease progression on anti-PD-1/PD-L1 therapies.
Humana · Effective Oct 1, 2026High impact
Bariatric Surgery - Medicare Advantage (Revised)
This is a comprehensive Medicare Advantage bariatric surgery coverage policy (HUM-1020-005) effective October 1, 2026, that outlines coverage determinations, limitations, and coding requirements for various bariatric procedures. The policy applies Humana's Medicare Advantage coverage standards and references applicable MAC Local Coverage Determinations by geographic jurisdiction, with specific rules varying by state and MAC region.
Humana · Effective Sep 23, 2026High impact
Cochlear Implant - MEDICAID - LOUISIANA (Revised)
This is a refreshed Louisiana Medicaid policy for cochlear implants effective 09/23/2026 that consolidates coverage criteria for unilateral and bilateral implants, postoperative services, and limitations. The policy requires prior authorization for ALL aspects of cochlear implant care (preoperative evaluation, implantation, repairs, supplies, and therapy). Key coverage requirement: patients under 21 must meet strict audiological, medical, and multidisciplinary team evaluation criteria, with bilateral implants requiring additional binaural benefit documentation. No specific billing codes are mentioned in the policy text.
Humana · Effective Sep 1, 2026High impact
Yervoy® (ipilimumab) (New)
Humana Medicaid Louisiana has implemented a NEW prior authorization policy for Yervoy (ipilimumab) effective September 1, 2026, covering seven cancer indications (melanoma, RCC, MSI-H colorectal cancer, hepatocellular carcinoma, NSCLC, mesothelioma, and esophageal cancer). The policy establishes specific clinical criteria for initial approval and renewal, with most indications requiring combination therapy with Opdivo (nivolumab) and maximum 4-month authorization periods. Billing teams must immediately identify Yervoy claims and implement prior authorization workflows before the effective date.
Humana · Effective Sep 1, 2026High impact
Spinal Fusion Surgery - Medicare Advantage (Revised)
This is a revised Medicare Advantage medical coverage policy for spinal fusion surgery (effective 09/01/2026) that consolidates coverage determination, limitations, coding information, and evidence summaries for cervical, lumbar, and thoracic spinal fusion procedures. The policy references multiple MAC-specific Local Coverage Determinations (LCDs) across geographic jurisdictions and outlines covered procedures including traditional fusion, minimally invasive approaches (DLIF, XLIF, MITLIF), sacroiliac joint fusion, and interlaminar fusion techniques. Billing teams must align claims submission with the applicable MAC LCD based on patient location and ensure procedures meet specific medical necessity criteria outlined in the referenced determinations.
Humana · Effective Sep 1, 2026High impact
Nivolumab products (Opdivo, Opdivo Qvantig) (New)
Humana Louisiana Medicaid has established a new prior authorization pharmacy coverage policy for Nivolumab products (Opdivo, Opdivo Qvantig) effective September 1, 2026, covering 17 cancer indications including melanoma, renal cell carcinoma, NSCLC, Hodgkin lymphoma, and others. The policy requires prior authorization for all covered indications with specific clinical criteria and exclusions (including disease progression on prior anti-PD-1/PD-L1 therapy). Initial and renewal approvals are valid for 6 months or as determined through clinical review.
Humana · Effective Sep 1, 2026High impact
Benign Prostatic Hyperplasia Treatments - Medicare Advantage (Revised)
This is a comprehensive Medicare Advantage coverage policy for Benign Prostatic Hyperplasia treatments effective September 1, 2026. The policy outlines coverage determinations for multiple BPH treatment modalities including surgical procedures (TURP, prostatectomy, laser therapies), temporary implanted devices, stents, and diagnostic testing. The policy references multiple MAC-specific Local Coverage Determinations (LCDs) that vary by geographic jurisdiction, requiring billing teams to verify applicable coverage rules based on patient location.
Humana · Effective Sep 1, 2026High impact
Ambulatory Cardiac Monitoring Devices - Medicare Advantage (Revised)
Humana Medicare Advantage has revised its Ambulatory Cardiac Monitoring Devices policy effective September 1, 2026. The policy provides updated coverage guidance for various cardiac monitoring technologies (Holter monitors, patch recorders, external loop monitors, implantable loop recorders, and mobile cardiac outpatient telemetry) with MAC-specific coverage determinations by geographic jurisdiction. The policy document appears incomplete but establishes that medical necessity determinations will follow applicable NCDs and LCDs based on the member's jurisdiction.
Humana · Effective Aug 26, 2026High impact
Breyanzi® (lisocabtagene maraleucel) (Revised)
Humana Louisiana Medicaid has revised its Breyanzi® (lisocabtagene maraleucel) pharmacy coverage policy effective August 26, 2026. The policy establishes prior authorization requirements for this CAR-T cell therapy across six hematologic malignancies (Large B-cell Lymphoma 3L/2L, CLL/SLL, Follicular Lymphoma, Mantle Cell Lymphoma, and Marginal Zone Lymphoma) with specific clinical criteria, exclusions, and a lifetime maximum of one dose per member. Billing teams must implement prior authorization workflows and verify member eligibility against defined clinical criteria before claims submission.
Humana · Effective Aug 26, 2026High impact
Crisis Stabilization for Adults - MEDICAID - LOUISIANA (Revised)
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.
Humana · Effective Aug 6, 2026High impact
Neuroablative Techniques for Chronic Pain - Medicare Advantage (Revised)
This is a comprehensive Medicare Advantage coverage policy for neuroablative techniques used to treat chronic pain, effective 08/06/2026. The policy defines coverage criteria, eligible procedures (including radiofrequency ablation, cryoablation, chemical neurolysis, and specialized devices like Intracept), and references MAC-specific LCDs and billing codes by geographic jurisdiction. Billing teams must verify applicable MAC guidelines for their state and ensure claims comply with local coverage determinations.
Humana · Effective Aug 6, 2026High impact
Neuroablative Techniques for Chronic Pain - Medicare Advantage (Revised)
This is a comprehensive Medicare Advantage policy on neuroablative techniques for chronic pain management, effective 08/06/2026. The policy defines covered denervation procedures (radiofrequency ablation, cryoablation, facet denervation, basivertebral nerve ablation, and others) and references MAC-specific LCDs and NCDs that vary by geographic jurisdiction. Billing teams must verify applicable MAC requirements for their region before processing claims for these procedures.
Humana · Effective Aug 3, 2026High impact
Genetic Testing for Hereditary Cancer - Medicare Advantage (Revised)
This is a comprehensive Medicare Advantage policy on genetic testing for hereditary cancer syndromes, effective August 3, 2026. The policy establishes coverage guidelines for germline genetic testing across multiple cancer types (melanoma, gastric cancer, neuroendocrine tumors, renal cell carcinoma, and others) and references specific MAC-based Local Coverage Determinations (LCDs) that vary by geographic jurisdiction. Billing teams must verify applicable MAC jurisdiction and LCD requirements before processing claims.
Humana · Effective Aug 3, 2026High impact
Breast Reconstruction - Medicare Advantage (Revised)
Humana Medicare Advantage has revised its breast reconstruction coverage policy (effective 08/03/2026) to clarify medical necessity criteria for reconstruction procedures following mastectomy, trauma, or congenital abnormalities. The policy applies MAC-specific Local Coverage Determinations (LCDs) by geographic jurisdiction and establishes criteria for determining coverage of implant removal, reduction mammaplasty, and related procedures. Billing teams must identify the appropriate MAC jurisdiction for each claim and apply the correct LCD requirements.
Humana · Effective Aug 3, 2026High impact
Breast Excision and Mastectomy - Medicare Advantage (Revised)
Humana Medicare Advantage has updated its Breast Excision and Mastectomy policy (HUM-1254-009) effective 08/03/2026. This revised policy clarifies coverage criteria for breast lesion excisions (CPT 19120, 19125), partial mastectomies (CPT 19301, 19302), and gynecomastia mastectomy (CPT 19300) across multiple MAC jurisdictions. The policy establishes specific medical necessity criteria based on biopsy results, lesion characteristics, and anatomical considerations, and applies jurisdiction-specific Local Coverage Determinations (LCDs) for Medicare Administrative Contractors.
Humana · Effective Aug 3, 2026High impact
Benign Prostatic Hyperplasia Treatments - Medicare Advantage (Revised)
This is a comprehensive Medicare Advantage policy for Benign Prostatic Hyperplasia (BPH) treatments that became effective on August 3, 2026. The policy outlines coverage for multiple surgical and minimally invasive treatment modalities including TURP, laser therapies, temporary implanted devices, and stents, with specific coverage determinations varying by MAC jurisdiction. Billing teams must verify applicable MAC-specific LCDs and NCDs by geographic location before processing BPH treatment claims.
Ambetter · Effective Aug 1, 2026High impact
Louisiana House Bill 1196: Preventive Colonoscopy Services and Claims Submission Requirements
Louisiana House Bill 1196 requires providers to use appropriate preventive screening modifiers when billing for colonoscopy services effective August 1, 2026. This includes preventive screening colonoscopies with polyp/tissue removal and provider-recommended follow-up screening colonoscopies performed per NCCN guidelines. Claims submitted without the correct preventive modifiers may not process as intended and could be denied.
Ambetter · Effective Jul 29, 2026High impact
Marketplace 86X Provider Manual Update and Behavioral Health TOB Billing Guidance
Ambetter from Louisiana Healthcare Connections has updated billing requirements for behavioral health services, effective July 29, 2026. Providers must now use specific Type of Bill (TOB) codes based on the level of care: 86X for Residential Treatment Centers, 11X for inpatient hospital services, 13X for outpatient hospital services, and 76X for Community Mental Health Centers. Incorrect TOB, Place of Service, or revenue code usage will result in claim denials or processing delays.
Humana · Effective Jul 29, 2026High impact
Documentation Requirements for Hysterectomy and Sterilization - MEDICAID - LOUISIANA (New)
Louisiana Medicaid (Humana Healthy Horizons) implemented new documentation requirements for hysterectomy and sterilization procedures effective 07/29/2026. Billing teams must ensure providers obtain and submit specific consent forms (BHSF Form 96-A for hysterectomy; HHH-687/HHH-687-1 for sterilization) signed by required parties before claims can be processed and reimbursed. Claims will be denied without proper documentation, witness signatures when applicable, and name verification.
Louisiana Medicaid · Effective Jul 20, 2026High impact
Louisiana Medicaid Pharmacy – Tropical Storm Bertha Preparation – July 2026
Louisiana Medicaid is temporarily waiving early refill edits and automatically extending all prior authorizations for non-controlled pharmacy claims through July 28, 2026, to help beneficiaries maintain medication access during Tropical Storm Bertha. These emergency flexibilities apply to both Fee-for-Service and Managed Care Organization claims but explicitly exclude controlled substances.
Humana · Effective Jul 20, 2026High impact
Chiropractic - In Lieu of Services (ILOS) - MEDICAID - LOUISIANA (Revised)
Humana Healthy Horizons Louisiana Medicaid now covers chiropractic services as an In Lieu of Services (ILOS) alternative for members 21+ with neuromusculoskeletal spine conditions. Up to 18 treatment sessions are covered annually without prior authorization; additional sessions require plan approval. Initial visits must include a documented treatment plan with care level, goals, and effectiveness measures. Spinal manipulation is limited to 5 regions per visit, with maximum 2 additional treatments (dry needling, electrical stimulation, manual therapy, etc.) allowed per date of service.
Ambetter · Effective Jul 6, 2026High impact
InterQual 2026 Implementation Provider Notice: Effective 7/6/2026
Louisiana Healthcare Connections will implement InterQual 2026 criteria effective July 6, 2026 for utilization management reviews across both physical and behavioral health services. This evidence-based decision support tool will be used to screen medical necessity for procedures, durable medical equipment, and imaging services. Providers must access updated InterQual SmartSheets through the secure provider portal to stay current with new criteria.
Humana · Effective Jul 1, 2026High impact
Humana Physician News: Q2 2026
This Q2 2026 Humana newsletter (published April 1, 2026, discovered November 1, 2026) contains multiple effective dates spanning past, ongoing, and future actions. Key changes include: (1) New prior authorization lists effective July 1, 2026, for Medicare Advantage, Dual Eligible SNPs, and Medicaid plans; (2) Medicaid provider-administered medication PAL changes for seven states; (3) PPO members inactive since May 1, 2024, were automatically unpaneled as of March 1, 2026; (4) New claims-based attribution rules for MA products effective April 1, 2026; and (5) Published claims payment policies including a new Paper Claim Administrative Fee. The newsletter emphasizes timely prior authorization submission before services are fully furnished to avoid claim denial and retroactive authorization processing.
Humana · Effective Jul 1, 2026High impact
Pembrolizumab products (Keytruda, Keytruda Qlex)
Humana Louisiana Medicaid has issued a new Prior Authorization policy effective July 1, 2026 for Pembrolizumab products (Keytruda IV powder, Keytruda IV solution, and Keytruda Qlex subcutaneous solution) covering 26 cancer indications. All pembrolizumab prescriptions for these conditions now require prior authorization approval before dispensing, with specific clinical criteria and exclusions that must be documented by providers.
Humana · Effective Jul 1, 2026High impact
Pembrolizumab products (Keytruda, Keytruda Qlex) (New)
Humana Medicaid-Louisiana has implemented a new Prior Authorization policy effective July 1, 2026 for Pembrolizumab products (Keytruda IV/powder and Keytruda Qlex subcutaneous). The policy covers 25+ cancer indications with specific clinical criteria, biomarker requirements (PD-L1/CPS scores, MSI-H/dMMR status), and treatment regimens. All uses require prior authorization with 6-month approval durations.
Ambetter · Effective Jun 15, 2026High impact
Intraoperative Neurophysiologic Monitoring (IONM) Update: Effective 6/15/26
Ambetter from Louisiana Healthcare Connections is implementing new billing and coverage requirements for Intraoperative Neurophysiologic Monitoring (IONM) services effective June 15, 2026. Only CMS-recognized payable code 95940 with modifier G0453 will be reimbursed for Marketplace plans, while code 95941 is now non-covered. Billing must comply with strict criteria including exclusive patient attention, maximum 4 units per 60 minutes, and appropriate place of service codes.
Humana · Effective Jun 1, 2026High impact
Darzalex Faspro™ (daratumumab and hyaluronidase- fihj) (Revised)
This is a revised Humana Medicaid (Louisiana) prior authorization policy for Darzalex Faspro (daratumumab and hyaluronidase-fihj) effective June 1, 2026, with updates as of September 23, 2026. The policy establishes coverage criteria for three indications: multiple myeloma (newly diagnosed and relapsed/progressive), light chain amyloidosis, and high-risk smoldering multiple myeloma, with specific combination therapy requirements and monotherapy eligibility thresholds. The policy excludes coverage for patients with disease progression while taking daratumumab and requires prior authorization before dispensing.
Humana · Effective Jun 1, 2026High impact
Enhertu (fam-trastuzumab deruxtecan-nxki)
Humana Louisiana Medicaid has released a new prior authorization policy for Enhertu (fam-trastuzumab deruxtecan-nxki) effective June 1, 2026, covering six oncology indications including HER2-positive/low/ultralow breast cancer, gastric adenocarcinoma, HER2-mutant NSCLC, and HER2-positive solid tumors. The policy establishes specific clinical criteria for approval and requires prior authorization before dispensing, with disease progression on Enhertu as an automatic exclusion for renewal.
Humana · Effective May 1, 2026High impact
Imfinzi (durvalumab)
Humana Louisiana Medicaid has established a new prior authorization policy for Imfinzi (durvalumab) effective May 1, 2026, covering nine cancer indications. The policy requires prior authorization for all uses, with specific clinical criteria and exclusions for each indication (e.g., disease progression on prior anti-PD-1/PD-L1 therapy). Billing and clinical teams must verify member eligibility, confirm diagnosis matches policy criteria, and submit prior authorization requests before dispensing.
Humana · Effective May 1, 2026High impact
Kymriah™ (tisagenlecleucel) (Revised)
Humana Louisiana Medicaid revised its Kymriah (tisagenlecleucel) prior authorization policy effective May 1, 2026. The policy maintains coverage for three indications (DLBCL, ALL, and Follicular Lymphoma) with updated approval criteria and exclusions. Key requirements include prior authorization through the Corporate Transplant Department, lymphodepleting chemotherapy regimens (unless contraindicated), and a maximum of one dose per lifetime. Multiple exclusions apply, including prior gene therapy, prior anti-CD19 therapy, active hepatitis B/C, HIV/AIDS, and prior allogeneic transplant for lymphoma patients.
Humana · Effective May 1, 2026High impact
Breyanzi® (lisocabtagene maraleucel) (Revised)
Humana Louisiana Medicaid revised its Breyanzi® (lisocabtagene maraleucel) prior authorization policy effective May 1, 2026, covering six hematologic malignancies (Large B-cell Lymphoma 3L/2L, CLL/SLL, Follicular Lymphoma, Mantle Cell Lymphoma, and Marginal Zone Lymphoma). The policy requires prior authorization for all indications with specific clinical criteria, mandatory lymphodepleting chemotherapy co-treatment, and a lifetime maximum of one dose. Key exclusions include prior CD-19 CAR-T therapy, active hepatitis B/C, HIV/AIDS, CNS lymphoma, and prior allogeneic transplant.
Humana · Effective May 1, 2026High impact
Abecma® (idecabtagene vicleucel) (Revised)
This is a revised Humana Medicaid (Louisiana) prior authorization policy for Abecma® (idecabtagene vicleucel), a CAR-T cell therapy for relapsed or refractory multiple myeloma. The policy requires prior authorization before dispensing, with approval limited to one dose per lifetime over a 60-day duration. Key clinical criteria include diagnosis confirmation, relapsed/refractory disease per IMWG standards, at least two prior lines of therapy (immunomodulatory agent, proteasome inhibitor, anti-CD38 monoclonal antibody), age ≥18 years, and concurrent lymphodepleting chemotherapy. Three exclusions apply: active hepatitis B/C, prior allogeneic transplant, or prior CAR-T therapy.
Humana · Effective May 1, 2026High impact
Imfinzi (durvalumab) (New)
Humana Medicaid Louisiana is implementing a new prior authorization policy for Imfinzi (durvalumab), an intravenous cancer therapy. This policy establishes specific coverage criteria for multiple oncology indications including lung cancers, biliary tract cancer, endometrial cancer, and other malignancies, with 6-month approval periods.
Molina Healthcare · Effective Apr 1, 2026High impact
PDF Version
Molina Care Connections expands telehealth and in-person nurse practitioner services across 22 states with open scheduling for preventive care and chronic condition management. Developmental screening requirements for children ages 1-3 now mandate use of standardized global screening tools (CPT 96110) with specific documentation; domain-specific tools (M-CHAT, ASQ:SE) are no longer billable for this measure. Utilization management criteria and processes remain unchanged but are clarified for provider reference.
Humana · Effective Mar 18, 2026High impact
Home Health - MEDICAID - LOUISIANA (Revised)
This policy establishes comprehensive home health service coverage and requirements for Louisiana Medicaid members, including prior authorization requirements for most services, face-to-face encounter documentation, and specific criteria for skilled nursing and home health aide services.
Humana · Effective Feb 1, 2026High impact
Gazyva® (obinutuzumab)
Humana Louisiana Medicaid has implemented a new prior authorization policy for Gazyva (obinutuzumab) effective February 1, 2026, covering three indications: chronic lymphocytic leukemia, follicular lymphoma, and lupus nephritis. The policy establishes specific clinical criteria for approval, including required combination therapies, disease status requirements, and maintenance therapy limits. Billing teams must implement prior authorization requirements before claims submission to avoid denials.
Humana · Effective Feb 1, 2026High impact
Pembrolizumab products (Keytruda, Keytruda Qlex) (New)
Humana has implemented a new prior authorization policy for Pembrolizumab products (Keytruda and Keytruda Qlex) for Louisiana Medicaid members effective February 1, 2026. The policy covers 31 different cancer indications with specific criteria, combination therapy requirements, and 6-month approval durations.
Humana · Effective Jan 7, 2026High impact
Chiropractic - In Lieu of Services (ILOS) - MEDICAID - LOUISIANA (New)
Humana Healthy Horizons in Louisiana is implementing a new chiropractic In Lieu of Services (ILOS) policy for Medicaid members 21+ years old, covering up to 18 visits without prior authorization. Visits beyond 18 require prior authorization, and specific documentation requirements apply for treatment plans and progress notes.
Humana · Effective Jan 1, 2026High impact
Rituximab products (Revised)
Humana Louisiana Medicaid updated prior authorization requirements for rituximab products (Rituxan, Ruxience, Riabni, Truxima) across multiple conditions including cancers, autoimmune diseases, and rheumatoid arthritis. The policy establishes specific approval criteria and exclusions for each indication, with preference given to biosimilar products Ruxience and Riabni over brand-name Rituxan and Truxima.

Get alerts for changes like this

Save a search and get email alerts when a new policy change matches your filters: daily or weekly, your choice, on every plan.

Create a free alert How Policy Monitoring works

Evolent Musculoskeletal Program Updates Effective 12.5.26

New oncology prior authorization code updates

LTC Monthly Processing Schedule for Calendar Year 2027

Ambetter from Louisiana Healthcare Connections Billing Code Update for various HCPC H Codes: Effective 01/01/2027

Pembrolizumab products (Keytruda, Keytruda Qlex) (New)

Enhertu (fam-trastuzumab deruxtecan-nxki) (New)

Wheelchair, Wheelchair Repairs, Standing Frame, and Patient Lift - MEDICAID - LOUISIANA (Revised)

Applied Behavior Analysis - MEDICAID - LOUISIANA (Revised)

Skin and Tissue Substitutes - MEDICAID - LOUISIANA (Revised)

Applied Behavior Analysis - MEDICAID - LOUISIANA (Revised)

Molecular Biomarkers for Prostate Cancer Risk Stratification - Medicare Advantage (Revised)

Imfinzi (durvalumab) (New)

Bariatric Surgery - Medicare Advantage (Revised)

Cochlear Implant - MEDICAID - LOUISIANA (Revised)

Yervoy® (ipilimumab) (New)

Spinal Fusion Surgery - Medicare Advantage (Revised)

Nivolumab products (Opdivo, Opdivo Qvantig) (New)

Benign Prostatic Hyperplasia Treatments - Medicare Advantage (Revised)

Ambulatory Cardiac Monitoring Devices - Medicare Advantage (Revised)

Breyanzi® (lisocabtagene maraleucel) (Revised)

Crisis Stabilization for Adults - MEDICAID - LOUISIANA (Revised)

Neuroablative Techniques for Chronic Pain - Medicare Advantage (Revised)

Neuroablative Techniques for Chronic Pain - Medicare Advantage (Revised)

Genetic Testing for Hereditary Cancer - Medicare Advantage (Revised)

Breast Reconstruction - Medicare Advantage (Revised)

Breast Excision and Mastectomy - Medicare Advantage (Revised)

Benign Prostatic Hyperplasia Treatments - Medicare Advantage (Revised)

Louisiana House Bill 1196: Preventive Colonoscopy Services and Claims Submission Requirements

Marketplace 86X Provider Manual Update and Behavioral Health TOB Billing Guidance

Documentation Requirements for Hysterectomy and Sterilization - MEDICAID - LOUISIANA (New)

Louisiana Medicaid Pharmacy – Tropical Storm Bertha Preparation – July 2026

Chiropractic - In Lieu of Services (ILOS) - MEDICAID - LOUISIANA (Revised)

InterQual 2026 Implementation Provider Notice: Effective 7/6/2026

Humana Physician News: Q2 2026

Pembrolizumab products (Keytruda, Keytruda Qlex)

Pembrolizumab products (Keytruda, Keytruda Qlex) (New)

Intraoperative Neurophysiologic Monitoring (IONM) Update: Effective 6/15/26

Darzalex Faspro™ (daratumumab and hyaluronidase- fihj) (Revised)

Enhertu (fam-trastuzumab deruxtecan-nxki)

Imfinzi (durvalumab)

Kymriah™ (tisagenlecleucel) (Revised)

Breyanzi® (lisocabtagene maraleucel) (Revised)

Abecma® (idecabtagene vicleucel) (Revised)

Imfinzi (durvalumab) (New)

PDF Version

Home Health - MEDICAID - LOUISIANA (Revised)

Gazyva® (obinutuzumab)

Pembrolizumab products (Keytruda, Keytruda Qlex) (New)

Chiropractic - In Lieu of Services (ILOS) - MEDICAID - LOUISIANA (New)

Rituximab products (Revised)