Louisiana Medicaid managed care: what plans must pay
Managed-care plans don't publish their provider fee schedules. What is public is the rule each plan must follow, set in Louisiana's plan contracts, statutes and notices. For 19 of 21 service lines, plans must follow a rule tied to the state's published rates.
- Lines with a binding rule
- 19of 21
- Plans on record
- 9
- Directed payments
- 11amounts in the workspace
- Capitation cells
- 326PMPM rates in the workspace
Who sets the rate, by service line
The main rule Louisiana's managed-care plans follow for each service line, in plain language.
| Service line | Main rule for plans | Rates | Also applies |
|---|---|---|---|
| Physician & professional | Plans must pay at least thisPlans must pay at least the published rate | 52,250 | Paid by the state, outside plans |
| Lab & pathology | Plans must pay at least thisPlans must pay at least the published rate | 6,685 | Paid by the state, outside plans |
| Radiology | Plans must pay at least thisPlans must pay at least the published rate | 2,414 | Paid by the state, outside plans |
| Clinics (FQHC/RHC) | Plans must pay at least thisPlans must pay at least the published rate | 2,136 | |
| Equipment & supplies | Plans must pay at least thisPlans must pay at least the published rate | 1,832 | Paid by the state, outside plans |
| Hospital inpatient | Plans must pay at least thisPlans must pay at least the published rate | 628 | |
| Behavioral health | Plans must pay at least thisPlans must pay at least the published rate | 476 | Paid by the state, outside plans |
| Pharmacy | Plans must pay at least thisPlans must pay at least the published rate | 433 | Paid by the state, outside plans |
| Dental | Plans must pay at least thisPlans must pay at least the published rate | 424 | |
| Therapy (PT/OT/speech) | Plans must pay at least thisPlans must pay at least the published rate | 399 | Paid by the state, outside plans |
| Hospital outpatient | Plans must pay at least thisPlans must pay at least the published rate | 197 | State sets the plan rate |
| IDD services | Paid by the state, outside plansPaid directly by the state, outside managed care | 166 | |
| Vision & hearing | Plans must pay at least thisPlans must pay at least the published rate | 121 | |
| Other home & community services | Paid by the state, outside plansPaid directly by the state, outside managed care | 109 | Plans must pay at least this |
| Hospice | Plans must pay at least thisPlans must pay at least the published rate | 66 | |
| Transportation | Plans must pay at least thisPlans must pay at least the published rate | 57 | Paid by the state, outside plans |
| Private duty nursing | Plans must pay at least thisPlans must pay at least the published rate | 33 | Paid by the state, outside plans |
| Personal care & attendant | Paid by the state, outside plansPaid directly by the state, outside managed care | 25 | Plans must pay at least this |
| ABA / autism services | Plans must pay at least thisPlans must pay at least the published rate | 24 | |
| Home health | Plans must pay at least thisPlans must pay at least the published rate | 20 | Paid by the state, outside plans |
| Other | State-directed paymentDirected payments add to plan rates | 11 |
Louisiana Medicaid managed-care plans
9 plans on record across 3 programs.
State-directed payments and capitation
Payments CMS approved under 42 CFR 438.6(c) that plans must make on top of, or as a minimum for, their negotiated rates, and 326 published capitation cells.
Frequently asked questions
Do Louisiana Medicaid plans have to pay the state fee schedule?
For some services. Plans must follow a rule tied to the state's rates for: Physician & professional, Lab & pathology, Radiology, Clinics (FQHC/RHC), Equipment & supplies, Hospital inpatient, Behavioral health, Pharmacy, Dental, Therapy (PT/OT/speech), Hospital outpatient, Vision & hearing, Other home & community services, Hospice, Transportation, Private duty nursing, Personal care & attendant, ABA / autism services, Home health. For other lines, plans negotiate rates with providers.
Where do these rules come from?
From Louisiana's managed-care plan contracts, state statutes and regulations, provider notices and CMS-approved directed-payment filings. Each rate in the workspace carries its citation.
Can I see what each plan actually pays?
No plan publishes its provider fee schedule. The closest public signals are the binding rules above, state-set rates, directed payments and the state's own payment-level estimates in its directed-payment filings.