Freestanding Psychiatric Hospital for Adults - In Lieu of Service - MEDICAID - LOUISIANA

This Humana Healthy Horizons Louisiana ILOS policy covers freestanding psychiatric hospital admission as a substitute for general hospital inpatient psychiatric unit care for adult members, primarily specified as ages 21-64, who meet MCG Guidelines and have behavioral health needs that would otherwise require a general hospital psychiatric unit. Prior authorization is required, admissions must meet MCG criteria and medical necessity, and claims may be subject to clinical review. The policy emphasizes the service is a voluntary, cost-effective substitute under ILOS rules (42 CFR § 438.3(e)(2)).

"The purpose of offering this In Lieu of Service (ILOS) is to provide coverage for freestanding psychiatric hospitalization for members aged 21 and older."

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