NOTE: §1081.13 eff. upon an Act of the Louisiana Legislature containing a specific appropriation of monies for the implementation of Act 367 of the 2025 Regular Session becomes effective. See Acts 2025, No. 367.

§1081.13. Medicaid coverage; amino acid-based elemental formulas

            A. The Louisiana Department of Health shall make available to persons who are eligible for Medicaid benefits under Title XIX of the Social Security Act, 42 U.S.C. 1396 et seq., coverage for amino acid-based elemental formulas, regardless of the formula delivery method, to treat a child aged two years or younger. Coverage applies pursuant to this Section if the child has been diagnosed by a board-certified allergist or board-certified gastroenterologist and the treating physician issues a written order stating that the amino acid-based elemental formula is medically necessary to treat the child for any of the following:

            (1) Immunoglobulin E and non-immunoglobulin E mediated allergies to multiple food proteins.

            (2) Severe food protein-induced enterocolitis syndrome.

            (3) Eosinophilic disorders, as evidenced by the results of a biopsy.

            (4) Impaired absorption of nutrients caused by disorders affecting the absorptive surface, functional length, and motility of the gastrointestinal tract.

            B. Coverage provided pursuant to this Section may be subject to copayments, deductibles, or other cost-sharing mechanisms.

            C.(1) A health maintenance organization, health insurance organization, or managed care organization that contracts with the state to provide or coordinate healthcare services to any person eligible for Medicaid shall provide coverage on a basis no less favorable than the basis on which prescription drugs and other medications and related services are covered by the organization, and to the same extent that the organization provides coverage for drugs that are available only on the orders of a physician.

            (2) A utilization review agent acting on behalf of an organization listed in this Subsection may review a treating physician's determination of the medical necessity of the use of an amino acid-based elemental formula for the treatment of a covered infant or child who is diagnosed with a disease or disorder listed in Subsection A of this Section.

            Acts 2025, No. 367, §2, See Act.