MedicaidPrior AuthMedium impact
EPSDT Personal Care Services - MEDICAID - LOUISIANA (Revised)
Humana·LA · Pediatrics, Physical Therapy, Occupational Therapy·Medicaid
Effective date
Jul 20, 2026
We identified it
Jul 16, 2026
Summary
This is a routine annual review of the Louisiana Medicaid EPSDT Personal Care Services policy (effective 07/20/2026) with no coverage changes. The policy clarifies that PCS are medically necessary services for eligible members up to age 21 with functional impairments in at least two ADLs. All EPSDT-PCS require prior authorization with specific documentation, including a prescription, face-to-face assessment, and completed forms (90-day assessment, daily schedule, social assessment). Chronic Needs Cases have a simplified PA process requiring only a PA-14 form with provider verification every 180 days.
Action Required
Before 07/20/2026: Billing team must ensure prior authorization workflows for EPSDT-PCS are properly configured in billing software. Verify that all PA requests include: (1) proof of Humana Healthy Horizons Louisiana plan eligibility, (2) signed practitioner prescription for services not exceeding 180 days, (3) completed Request for EPSDT PCS form 90 with face-to-face assessment documentation confirming at least 2 ADL impairments, (4) EPSDT-PCS Daily Schedule form, (5) EPSDT-PCS Social Assessment form, and (6) PA-14 form. For Chronic Needs Cases designated by the MCO, streamline subsequent PA requests (every 180 days) to require only PA-14 form plus practitioner statement verifying condition status. Update billing staff training on eligibility requirements: member must be age birth through 20 years, enrolled in Humana Healthy Horizons Louisiana, and have medically necessary prescription from licensed practitioner. Flag that any PA request for service increases (above approved levels) requires full review with all documentation. Failure to submit complete PA documentation will result in claim denials.