MedicaidCoverageMedium impact
Multi-Systemic Therapy - MEDICAID - LOUISIANA (Revised)
Humana·LA · Psychiatry, Pediatrics, Family Medicine·Medicaid
Effective date
Aug 5, 2026
We identified it
Aug 4, 2026
Summary
This is a revised Multi-Systemic Therapy (MST) policy for Louisiana Medicaid that clarifies coverage criteria for intensive home/family-based treatment for youth ages 12-17 at risk of out-of-home placement. The policy defines eligibility requirements for initial MST courses (up to 5 months), continuation of services, additional courses, and discharge criteria. Key requirement: members must have externalizing behaviors with DSM-5 diagnoses (conduct disorder, ODD, etc.), documented failure of less intensive treatment, and active family involvement. The policy became effective 08/05/2026 with a review date of 10/07/2025.
Action Required
Before 08/05/2026: Billing and authorization teams must implement new prior authorization protocols for MST services. (1) Update the authorization system to require prior auth for all initial MST requests, continuation requests, and additional course requests for Louisiana Medicaid members ages 12-17. (2) Create authorization checklist requiring submission of: psychosocial assessment, case summary, treatment plan, and supporting clinical records for each authorization request. (3) Train Prior Auth staff to verify all eligibility criteria are met (age 12-17, externalizing behaviors with conduct disorder/ODD diagnosis, at-risk for out-of-home placement, failed less intensive treatment, family involvement). (4) Implement system edits to deny requests that meet any exclusion criteria (primary suicidal/homicidal/psychotic presentation, youth living independently without identifiable caregiver, sexual offending only, autism spectrum disorder diagnosis, low-level need, or prior MST receipt without documented changed circumstances). (5) Update denial templates to cite specific policy sections when coverage limits apply. Failure to implement proper authorization controls will result in claim denials and compliance violations.