IB 21-17: Changes to Durable Medical Equipment, Pediatric Day Health Care, Home Health, Rehabilitation and Personal Care Services, and Pharmacy Due to Tropical Storm Ida (Hurricane Ida) (revised 8.27.01)
Date: 08/27/21
On August 26, 2021, Governor John Bel Edwards declared a state of emergency ahead of Tropical Storm Ida, as significant impact to the state is expected. This policy change is effective August 27, 2021 and shall only be applicable for parishes that have instituted mandatory evacuations. LDH will notify Louisiana Healthcare Connections when this temporary policy change ends.
Durable Medical Equipment, Pediatric Day Health Care, Home Health, Rehabilitation and Personal Care Services
The Louisiana Department of Health (LDH) is directing all MCOs to ensure that any member who is in need of replacement durable medical equipment (DME) or supplies previously approved by the MCO may contact any durable medical equipment provider contracted with the MCO to obtain a replacement. Members shall not be required to have a new prescription and medical documentation for the replacement equipment or supplies.
Beneficiaries who were approved to receive medical equipment, supplies, home health services, pediatric day health care, rehabilitation or personal care services from a provider that is no longer in business or unable to provide the approved equipment, supplies or services may obtain the approved items or services from a new provider of their choice. The provider must be enrolled in Medicaid or contracted with an MCO. The MCO shall provide any necessary guidance to the provider on the cancelation of the original authorization and issuance of a new authorization, if applicable.
All other prior authorization requests shall continue to be subject to the applicable requirements to establish medical necessity.
Pharmacy
LDH is directing MCOs to lift the following edits for Medicaid beneficiaries who live in parishes with mandatory evacuation orders.The edits should be changed from a denial to educational, or bypass within 24 hours of this notice for the affected areas.
Early refills on non-controlled medications – should be bypassed or allow a pharmacist override, except for controlled and/or specialty drugs.
Prior authorization on non-controlled medications – should be bypassed or allow a pharmacist override, except for controlled and/or specialty drugs.
The standard emergency override should still be made available to pharmacies.
This pharmacy policy change is only applicable for residents in parishes with mandatory evacuation orders and should be based on the beneficiary’s home address. These edits should NOT require a phone call to the Pharmacy Benefit Manager for override.
Providers are encouraged to check for additional updates to Informational Bulletin 21-17 (revised 8.27.21).