LAC 50:I.1513. Out-of-Network Providers

A. Out-of-network providers under single case agreements are not considered network providers and therefore are not subject to the requirements at 42 CFR § 438.602(b). Out-of-network providers do not have to be screened and/or enrolled in the department’s fee-for-service program. Additionally, emergency room physicians are only subject to 42 CFR § 438.602(b) to the extent they meet the definition of a network provider in 42 CFR § 438.2. B. The department may adopt limits or thresholds that require out-of-network providers to convert to an in-network status upon reaching a specific threshold of services provided to a network beneficiary or beneficiaries. A provider’s conversion to an in-network status triggers the requirement for the provider to be screened and enrolled pursuant to 42 CFR § 438.602(b)(1).