MedicaidPrior AuthMedium impact
Community Brief Crisis Support - MEDICAID - LOUISIANA (Revised)
Humana·LA · Psychiatry, Emergency Medicine·Medicaid
Effective date
Jul 20, 2026
We identified it
Jul 16, 2026
Summary
Humana Healthy Horizons Louisiana Medicaid updated its Community Brief Crisis Support (CBCS) policy effective 07/20/2026. CBCS services now require prior authorization beyond 16 units (increased from initial coverage without explicit unit limits). Key changes include: services limited to members age 21+, referrals required from Mobile Crisis Response/Behavioral Health Crisis Care/Crisis Stabilization providers, and explicit exclusions for SUD residential facilities, PRTFs, inpatient facilities, and incarcerated individuals. Initial encounters are subject to retrospective medical necessity review with potential claim recoupment if deemed unnecessary.
Action Required
By July 20, 2026: Billing team must implement prior authorization requirement for CBCS services exceeding 16 units in billing software. Update claim submission workflows to: (1) Flag any CBCS claims over 16 units for mandatory prior auth before processing; (2) Require providers to submit Service Authorization Requests with sufficient medical necessity documentation immediately following initial encounter to allow processing time; (3) Implement retrospective review process for initial CBCS encounters to verify medical necessity, with procedures to recoup payment if service determined unnecessary. Providers must verify member eligibility criteria (age 21+, appropriate referral source, not in excluded settings) before service delivery. Update credentialing/provider communications to clarify CBCS cannot be rendered in SUD residential facilities, PRTFs, inpatient psychiatric facilities, or for incarcerated individuals, and cannot duplicate services with established ACT, CPST, or PSR providers. Failure to obtain prior authorization for services beyond 16 units will result in claim denials.