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The Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing implemented a Medicaid expansion program under the provisions of Title XXI of the Social Security Act called the Louisiana Children's Health Insurance Program (LaCHIP) (Louisiana Register, Volume 24, Number 10). LaCHIP provided health care coverage to uninsured children up to age 19 with family income below 133 percent of the federal poverty level (FPL). The October 20, 1998 Rule was subsequently amended to: 1) implement the second phase of LaCHIP which expanded coverage to uninsured children with family income up to 150 percent of the FPL (Louisiana Register, Volume 25, Number 9); and 2) implement the third phase which expanded coverage to uninsured children with family income up to 200 percent of the FPL (Louisiana Register, Volume 26, Number 12).

The bureau promulgated an Emergency Rule to expand coverage to children under Title XXI of the Social Security Act by implementing a stand-alone State Children’s Health Insurance Program (SCHIP) to provide coverage of prenatal care services to low income, non-citizen women (Louisiana Register, Volume 33, Number 5). The department amended the provisions of the May 1, 2007 Emergency Rule to place these provisions in the appropriate place in the Louisiana Administrative Code (Louisiana Register, Volume 33, Number 12). The December 20, 2007 Emergency Rule was amended to further clarify the service limits and prior authorization criteria for SCHIP prenatal care services (Louisiana Register, Volume 34, Number 8). This proposed Rule is being promulgated to continue the provisions of the August 20, 2008 Emergency Rule.

Title 50

PUBLIC HEALTH—MEDICAL ASSISTANCE

Part III.  Eligibility

Subpart 11.  State Children’s Health Insurance Program

Chapter 203.Prenatal Care Services

§20301.General Provisions

A.Effective May 1, 2007, the Department of Health and Hospitals provides State Children's Health Insurance Program (SCHIP) coverage of prenatal care services to low income, non-citizen women as an expansion of coverage for children under Title XXI of the Social Security Act. SCHIP coverage of prenatal care services will be an expansion of coverage for children, from conception to birth, with income from 0 percent through 200 percent of the federal poverty level (FPL).

AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and Title XXI of the Social Security Act.

HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 35:

§20303.Eligibility Criteria

A.An applicant must be a Louisiana resident and cannot be eligible for Medicaid benefits under the provisions of Title XIX of the Social Security Act.

B.Applicants must be uninsured at the time of application.

1.Applicants are considered to be uninsured if they do not have creditable health insurance that provides coverage of prenatal care services.

C.Recipients must have family income at or below 200 percent of the FPL.

D.Recipients cannot be covered under a group health insurance plan or have creditable health insurance coverage and cannot have access to a state employee health benefits plan.

1.A state employee health benefits plan is a plan that is offered or organized by the state government, or on behalf of state employees, or other public agency for employees within the state.

E.Recipients shall be eligible to receive SCHIP coverage of prenatal care services from the month of conception or the first month of eligibility following conception, whichever is later, through the month of birth.

AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and Title XXI of the Social Security Act.

HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 35:

§20305.Services

A.Covered Services. Recipients shall receive coverage of pregnancy-related health care services and associated medically necessary services for conditions that, if not treated, would complicate the pregnancy. Pregnancy-related health care services which may be covered include:

1.inpatient and outpatient health care services;
2.physician services;
3.surgical services;
4.clinic and other ambulatory health care services;
5.prescription and over-the-counter medications;
6.laboratory and radiological services;
7.pre-natal care and pre-pregnancy family services and supplies;
8.inpatient and outpatient mental health services other than those services relative to substance abuse treatment;
9.durable medical equipment and other medically-related or remedial devices;
10.disposable medical supplies;
11.nursing care services;
12.extended dental services for pregnant women;
13.case management services;
14.physical therapy, occupational therapy and services for individuals with speech, hearing and language disorders;
15.medical transportation services; and
16.any other medically necessary medical, diagnostic, screening, preventive, restorative, remedial, therapeutic or rehabilitative services.

B.Service Exclusion. Sterilization procedures are not a covered service in this program.

C.Service Limits and Prior Authorization. Other Medicaid-specific benefit limits, age limits and prior authorization requirements may be applicable to the services covered in this program.

AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and Title XXI of the Social Security Act.

HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 35:

Family Impact Statement

In compliance with Act 1183 of the 1999 Regular Session of the Louisiana Legislature, the impact of this proposed Rule on the family has been considered. It is anticipated that this proposed Rule will have a positive impact on family functioning and autonomy as described in R.S. 49:942 by

Louisiana Register   Vol. 34, No. 10   October 20, 2008

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