This text of Louisiana § 46:460.77.1 (Behavioral health services claims; limitation on service hours; information) is published on Counsel Stack Legal Research, covering Louisiana primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.
§460.77.1. Behavioral health services claims; limitation on service hours; information
required for payment
A.
(1)For purposes of this Section, "CPST services" means community psychiatric
support and treatment services and "PSR services" means psychosocial rehabilitation
services.
(2)An individual behavioral health services provider rendering CPST services, PSR
services, or both shall be limited to a maximum combined total of twelve reimbursable hours
of CPST services and PSR services per rendering provider, per calendar day, regardless of
the number of patients seen by the rendering provider unless any of the following conditions
are met:
(a)The medical necessity of the services is documented for a Medicaid recipient
receiving more than twelve hours of CPST and PSR services per day per
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§460.77.1. Behavioral health services claims; limitation on service hours; information
required for payment
A.(1) For purposes of this Section, "CPST services" means community psychiatric
support and treatment services and "PSR services" means psychosocial rehabilitation
services.
(2) An individual behavioral health services provider rendering CPST services, PSR
services, or both shall be limited to a maximum combined total of twelve reimbursable hours
of CPST services and PSR services per rendering provider, per calendar day, regardless of
the number of patients seen by the rendering provider unless any of the following conditions
are met:
(a) The medical necessity of the services is documented for a Medicaid recipient
receiving more than twelve hours of CPST and PSR services per day per rendering provider.
(b) The services are billed for a group setting. However, the total hours worked by
an individual rendering provider shall not exceed twelve reimbursable hours per calendar
day.
(c) The services are billed for crisis intervention.
(3)(a) Services subject to the twelve-hour limitation provided in Paragraph (2) of this
Subsection include only CPST and PSR services rendered per individual National Provider
Identifier at one or more outpatient behavioral health services provider facilities or agencies
within a calendar day.
(b) The twelve-hour limitation provided in Paragraph (2) of this Subsection shall not
apply per individual behavioral health services provider agency.
(4)(a) Except as provided in Subparagraph (b) of this Paragraph, the provisions of this
Subsection shall apply exclusively to CPST services and PSR services.
(b) The provisions of this Subsection shall not apply to evidence-based practices
including, without limitation, the practices known as assertive community treatment,
multisystemic therapy, functional therapy, and homebuilders.
B. No managed care organization shall accept for payment a claim from a provider
of behavioral health services unless that claim includes all claim information required by
R.S. 40:2162.
C. The department shall include the limitation on reimbursable hours of CPST and
PSR services provided in Subsection A of this Section in each contract with a managed care
organization that covers behavioral health services.
D. Implementation of any provision of this Section shall be subject to approval by
the Centers for Medicare and Medicaid Services.