1. A. Medical claims for out-of-state services are honored when:

   1. 1. medical services are needed because of a medical emergency;
   2. 2. medical services are needed and the beneficiary’s health would be in danger if the beneficiary were required to travel to the beneficiary’s state of residence;
   3. 3. the state determines, on the basis of medical advice, that the needed medical services, or necessary supplementary resources, are more readily available in the other state; or
   4. 4. it is general practice for beneficiaries in a particular locality to use medical resources in another state.
2. B. Prior authorization is required for out-of-state non-emergency care.

Authority Note

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.

Historical Note

HISTORICAL NOTE: Promulgated by the Department of Health and Human Resources, LR 5:24 (February 1979), amended LR 6:491 (August 1980), amended by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 2:847 (May 2006), amended by the Department of Health, Bureau of Health Services Financing, LR 46:1393 (October 2020).