Assertive Community Treatment (ACT/FACT) - MEDICAID - LOUISIANA

This policy covers Assertive Community Treatment (ACT/Forensic ACT) — a long‑term, multidisciplinary, community‑based behavioral health service for Humana Healthy Horizons (Medicaid) members in Louisiana. It is limited to Medicaid‑eligible adults (≥18) with serious mental illness or complex behavioral health needs (including specified nursing facility residents and some forensic cases), requires prior authorization and medical necessity (meeting defined symptom/behavior thresholds and multidisciplinary recommendation, plus a comprehensive needs assessment within 30 days), excludes primary dementia as the principal diagnosis, and may not be billed concurrently with psychological evaluation or medication management.

"Level of Care Utilization System (LOCUS);"

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