1. A. The following services are not appropriate for personal care and are not reimbursable as EPSDT personal care services:

   1. 1. insertion and sterile irrigation of catheters (although changing of a catheter bag is allowable);
   2. 2. irrigation of any body cavities which require sterile procedures;
   3. 3. application of dressing, involving prescription medication and aseptic techniques, including care of mild, moderate or severe skin problems;
   4. 4. administration of injections of fluid into veins, muscles or skin;
   5. 5. administration of medicine (an EPSDT PCS direct service worker may only remind/prompt about self-administered medication to an EPSDT eligible beneficiary who is over the age of 18);
   6. 6. cleaning of the home in an area not occupied by the beneficiary;
   7. 7. laundry, other than that incidental to the care of the beneficiary;
   8. 8. shopping for groceries or household items other than items required specifically for the health and maintenance of the beneficiary, and not for items used by the rest of the household;
   9. 9. skilled nursing services, as defined in the state Nurse Practices Act, including medical observation, recording of vital signs, teaching of diet and/or administration of medications/injections, or other delegated nursing tasks;
   10. 10. teaching a family member or friend how to care for a beneficiary who requires frequent changes of clothing or linens due to total or partial incontinence for which no bowel or bladder training program for the patient is possible;

   11. 11. specialized nursing procedures such as:

       1. a. insertion of nasogastric feeding tube;
       2. b. in-dwelling catheter;
       3. c. tracheostomy care;
       4. d. colostomy care;
       5. e. ileostomy care;
       6. f. venipuncture; and/or
       7. g. injections;
   12. 12. rehabilitative services such as those administered by a physical therapist;
   13. 13. teaching a family member or friend techniques for providing specific care;
   14. 14. palliative skin care with medicated creams and ointments and/or required routine changes of surgical dressings and/or dressing changes due to chronic conditions;
   15. 15. teaching of signs and symptoms of disease process, diet and medications of any new or exacerbated disease process;

   16. 16. specialized aide procedures such as:

       1. a. rehabilitation of the beneficiary (exercise or performance of simple procedures as an extension of physical therapy services);
       2. b. measuring/recording the beneficiary’s vital signs (temperature, pulse, respirations and/or blood pressure, etc.) or intake/output of fluids;
       3. c. specimen collection;

       4. d. special procedures such as:

          1. i. nonsterile dressings;
          2. ii. special skin care (nonmedicated);
          3. iii. decubitus ulcers;;
          4. iv. cast care;
          5. v. assisting with ostomy care;
          6. vi. assisting with catheter care;
          7. vii. testing urine for sugar and acetone;
          8. viii. breathing exercises;
          9. ix. weight measurement; and
          10. x. enemas;
   17. 17. home IV therapy;
   18. 18. custodial care or provision of only instrumental activities of daily living tasks or provision of only one activity of daily living task;
   19. 19. occupational therapy;
   20. 20. speech pathology services;
   21. 21. audiology services;
   22. 22. respiratory therapy;
   23. 23. personal comfort items;
   24. 24. durable medical equipment;
   25. 25. oxygen;
   26. 26. orthotic appliances or prosthetic devices;
   27. 27. drugs provided through the Louisiana Medicaid pharmacy program;
   28. 28. laboratory services; and
   29. 29. social worker visits.

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 Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 21:947 (September 1995), repromulgated for LAC codification, LR 29:179 (February 2003), amended by the Department of Health, Bureau of Health Services Financing, LR 45:908 (July 2019).