Procedure for Submitting 148 Admission Forms (IB 23-02)

Date: 01/25/23

Louisiana Healthcare Connections is sharing an immediate change from the Louisiana Department of Health for nursing facilities when submitting 148 Admission Forms for individuals admitting to a nursing facility to receive post-acute care services under a contract or single case agreements. 

From the Provider Portal, the following fields should be entered:

Payment Source = “Other”

Free form text = “Medicaid Managed Care – [specified health plan] for [dates of contract]”

Submitting 148 Admission Forms in this manner will allow the Long Term Care Medicaid eligibility staff to account for single case agreements in effect that could be severed via Fee-for-Service coverage being approved at the admission date.

The Fee-for-Service eligibility consideration will start on the first day of the month of which the change from “Medicaid Managed Care” to “Medicaid Only” is reported by the provider via the 148 Status Change form.