1. A. The targeted population for ventilator care coordination shall consist of Medicaid beneficiaries, birth through age 25, who require the use of mechanical ventilation and are participants of the Children’s Choice Waiver (CC), New Opportunities Waiver (NOW), Residential Options Waiver (ROW), Early Steps Program, or meet requirements to receive Early Periodic Screening Diagnostic and Treatment (EPSDT) Targeted Case Management services as specified in LAC 50:XV.11303. Those eligible for and electing to receive ventilator care coordination may not receive other Medicaid-funded case management services.

2. B. Ventilator care coordination provides technical medical expertise relative to mechanical ventilation, including:

   1. 1. intensive case management that focuses on medical needs and addressing socioeconomic and environmental factors;
   2. 2. discussing with beneficiary/family when medical concerns arise and acting accordingly;
   3. 3. updating physicians on medical concerns/issues between hospitalizations to maximize patient care;
   4. 4. collaborating with skilled professionals to assess equipment needs for each beneficiary to ensure appropriateness;
   5. 5. advocating between the beneficiary/family, the supply/equipment vendor, and other providers when needed;
   6. 6. assessing beneficiary needs to have updated prescriptions for ventilator supplies and durable medical equipment;
   7. 7. working with the home health agency, family, and pharmacy to avoid the risk of medication reaction or error;
   8. 8. reviewing the home health agency’s plan of care to determine the accuracy and appropriateness of the services provided; and
   9. 9. providing training and technical assistance to care providers and agencies that administer the provision of care to promote the health and safety of ventilator care coordination beneficiaries in their homes, at school, and in the community.

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, Bureau of Health Services Financing, LR 51:2098 (December 2025).