1. A. The targeted population for the 1915(b)(3) services shall be Medicaid recipients who:

   1. 1. are at least 21 years of age;
   2. 2. have a qualifying mental health diagnosis;
   3. 3. meet medical necessity in accordance with LAC 50:I.1101; and
   4. 4. have transitioned from a nursing facility or been diverted from nursing facility level of care.

2. B. Recipients of personal care services (PCS) must meet the following additional recipient eligibility criteria:

   1. 1. recipients must be medically stable;
   2. 2. recipients shall not be enrolled in a Medicaid-funded program which offers a personal care service or related benefit; and
   3. 3. recipients’ care needs do not exceed that which can be provided under the scope and/or service limitations of PCS.
3. C. An adult with a diagnosis of a substance use disorder or intellectual and developmental disability without an additional co-occurring qualifying mental health diagnosis shall not meet the criteria for mental health services.

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 and the Office of Behavioral Health, LR 47:1874 (December 2021).