Managed care organization staff involved in certain audits, prior authorization determinations, or clinical reviews must get annual training, and they must help ensure providers are rostered, credentialed, or otherwise eligible. The department must also adopt rules to carry out the section.
§460.77.3. Staff training requirements A. Employees, contractors, and subcontractors of managed care organizations performing work or services related to the performance or supervision of audits, prior authorization determinations, and clinical reviews of mental health rehabilitation services providers shall receive annual training on Louisiana's Medicaid Behavioral Health Provider Manual and the relevant state laws, policies, and regulations related to the state's mental health rehabilitation program. B. Employees, contractors, and subcontractors of managed care organizations shall take all necessary steps to ensure mental health rehabilitation services providers are rostered, credentialed, or otherwise eligible to provide and be reimbursed for mental health rehabilitation services in accordance with R.S. 46:460.61. C. For purposes of this Section, the following definitions apply: (1) "Mental health rehabilitation" means an outpatient healthcare program provider of any psychosocial rehabilitation, crisis intervention, or community psychiatric support and treatment services that promotes the restoration of community functioning and well-being of an individual diagnosed with a mental health or mental or emotional disorder. A mental health rehabilitation provider uses evidence-based supports and interventions designed to improve individual and community outcomes. (2) "Mental health rehabilitation services" means outpatient services for adults with serious mental illness and children with emotional or behavioral disorders which are medically necessary to reduce the disability resulting from mental illness and assist in the recovery and resiliency of the recipient. Such services are home- and community-based and are provided on an as-needed basis to assist recipients in coping with the symptoms of their illness. The intent of mental health rehabilitation services is to minimize the disabling effects on the individual's capacity for independent living and to prevent or limit the periods of inpatient treatment. D. The department shall promulgate in accordance with the Administrative Procedure Act all rules as are necessary to implement the provisions of this Section. Acts 2021, No. 204, §2, eff. Jan. 1, 2022.