Louisiana - Adult Companion Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

Louisiana funds Adult Companion Care primarily through the New Opportunities Waiver (NOW), requiring providers to hold a Home and Community-Based Services (HCBS) Provider License under the Personal Care Attendant (PCA) or Monitored In-Home Caregiving module. The Louisiana Department of Health (LDH) Health Standards Section (HSS) regulates these agencies under Louisiana Administrative Code (LAC) Title 48, Part I, Chapter 50.

Before submitting a licensure application, prospective providers must secure Facility Need Review (FNR) approval from the LDH FNR committee. Once licensed, agencies enroll via the Gainwell Technologies provider portal to bill Medicaid for companion services.

1. Service Definition and Scope

In Louisiana, Adult Companion Care provides non-medical supervision and socialization to adults with developmental disabilities, enabling them to remain safely in their communities. This service is distinctly defined under the New Opportunities Waiver (NOW) provider manual.

The service focuses on assisting the participant with daily living tasks, socialization, and community integration, rather than providing hands-on nursing or medical care.

• Service Name: Adult Companion Care
• Primary Waiver: New Opportunities Waiver (NOW)
• Licensure Module: HCBS Provider License (PCA Module or Monitored In-Home Caregiving)
• Scope: Non-medical supervision and socialization
• Exclusions: Cannot duplicate hands-on personal care or skilled nursing services

2. Regulatory and Oversight Agencies

The Louisiana Department of Health (LDH) is the single state agency overseeing Medicaid and HCBS licensure. Within LDH, specific divisions handle distinct phases of the provider approval and oversight lifecycle.

Licensure is managed by the Health Standards Section, while waiver operations are directed by the Office for Citizens with Developmental Disabilities.

• Licensing Authority: LDH Health Standards Section (HSS) (https://ldh.la.gov/health-standards-section)
• Waiver Operating Agency: LDH Office for Citizens with Developmental Disabilities (OCDD) (https://ldh.la.gov/subhome/11)
• Medicaid Enrollment Portal: Louisiana Medicaid / Gainwell Technologies (https://www.lamedicaid.com)
• Rulemaking Body: Louisiana Division of Administration, Office of the State Register (https://www.doa.la.gov/doa/osr/)

3. Gatekeeping Prerequisites: Who Can Even Apply

Louisiana strictly controls the entry of new HCBS providers through a need-based assessment process. An applicant cannot simply submit a licensing application for the PCA module without prior authorization.

The mandatory prerequisite is Facility Need Review (FNR) approval. The state will reject any HCBS licensing application for the PCA module that does not include an FNR approval letter.

• Mandatory Prerequisite: Facility Need Review (FNR) approval from the LDH FNR committee
• Applicability: Required specifically for the Personal Care Attendant (PCA) module under the HCBS license
• Training Prerequisite: Completion of regulatory training videos posted on the HCBS web page prior to licensure application
• Entity Formation: Must be legally registered to conduct business in Louisiana

4. Licensure and Certification Requirements

Providers must obtain a Home and Community-Based Services (HCBS) Provider License from the LDH Health Standards Section. For Adult Companion Care, the agency must be approved for the Personal Care Attendant (PCA) module or the Monitored In-Home Caregiving module.

The application process requires submission of the HSS-HCBS-01 Licensure Application, non-refundable fees, and proof of commercial insurance.

• License Type: Home and Community-Based Services (HCBS) Provider License
• Required Module: Personal Care Attendant (PCA) or Monitored In-Home Caregiving
• Application Form: HSS-HCBS-01 Licensure Application
• Regulation Citation: LAC 48:I Chapter 50
• Insurance Requirement: General liability and worker's compensation with LDH HSS listed as certificate holder

5. Medicaid Provider Enrollment

After obtaining the HCBS license, the agency must enroll as a Louisiana Medicaid provider. Enrollment is processed through the Gainwell Technologies portal.

Providers must submit the Provider Enrollment Form (PE-50) and agree to abide by all rules established by CMS and LDH.

• Enrollment Portal: Louisiana Medicaid Provider Portal (https://www.lamedicaid.com)
• Primary Form: Provider Enrollment Form (PE-50)
• Prerequisite: Active HCBS Provider License from LDH HSS
• Agreement: Must sign the Louisiana Medicaid Provider Agreement

6. Staffing, Training and Background Checks

Direct care staff providing Adult Companion Care must meet minimum age, education, and background check requirements. Louisiana mandates strict criminal history checks for all unlicensed personnel.

Administrators must ensure that all staff complete required orientation and ongoing training as specified in the NOW provider manual and HCBS licensing standards.

• Background Checks: Mandatory criminal history and security checks per RS 40:2120.2
• Exemptions: SB 53 Act 57 (2020) provides specific exemptions for certain rehired persons
• Administrator Qualifications: Must meet education and experience standards outlined in LAC 48:I Chapter 50
• Staff Training: Must complete state-approved direct support worker training modules

7. Documentation, Policies and Records

Licensed HCBS providers must maintain comprehensive administrative and client records. Policies must align with the CMS Home and Community-Based Services Settings Rule.

Agencies must have an organizational chart, emergency preparedness plans, and detailed plans of care for each participant.

• Policy Manual: Must include incident reporting, client rights, and emergency preparedness
• Settings Rule: Policies must demonstrate compliance with the CMS HCBS Settings Rule
• Client Records: Must maintain individualized plans of care and daily service logs
• Business Operations: Must maintain at least one published business telephone number, returning calls within one business day

8. Billing, Rates and Claims

Adult Companion Care is billed in 15-minute increments according to the fee schedule published by Louisiana Medicaid for the New Opportunities Waiver.

Claims are submitted electronically via the Gainwell Technologies MMIS system. Providers must ensure that all billed time is supported by accurate, signed timesheets or electronic visit verification (EVV) data.

• Billing System: Gainwell Technologies MMIS
• Unit of Service: Typically billed in 15-minute increments
• Rate Source: Louisiana Medicaid NOW Fee Schedule
• Documentation Requirement: Electronic Visit Verification (EVV) or compliant timesheets required for all claims

9. Approval Sequence and Timeline

The approval sequence in Louisiana is strictly linear. An agency cannot apply for licensure without FNR approval, and cannot enroll in Medicaid without a license.

The entire process from FNR application to Medicaid enrollment can take several months, depending on the FNR committee's meeting schedule and HSS survey availability.

• Step 1: Submit Facility Need Review (FNR) application and await approval
• Step 2: Complete mandatory HCBS regulatory training videos and print certificates
• Step 3: Submit HSS-HCBS-01 Licensure Application with FNR approval and training certificates
• Step 4: Pass initial HSS licensing survey
• Step 5: Submit PE-50 to Gainwell Technologies for Medicaid enrollment

10. Common Denials and Survey Findings

Applications are frequently delayed or denied due to missing prerequisites, particularly the FNR approval or the required training certificates.

During initial surveys, HSS surveyors commonly cite agencies for incomplete policy manuals or failure to properly list LDH HSS as the certificate holder on insurance policies.

• Application Rejection: Submitting the HCBS application without FNR approval for the PCA module
• Training Deficiency: Failing to include printed certificates from the mandatory HSS training videos
• Insurance Error: Failing to include the 30-day cancellation notice requirement for LDH HSS on the certificate of insurance
• Survey Failure: Inability to demonstrate compliance with the HCBS Settings Rule during the initial site visit

11. Key Contacts and Resources

Providers should rely on the official LDH portals and published manuals for the most current regulations and forms.

The Health Standards Section and Gainwell Technologies provide dedicated help desks for licensing and enrollment inquiries.

• LDH Health Standards Section (HSS): https://ldh.la.gov/health-standards-section
• Louisiana Medicaid Enrollment (Gainwell): https://www.lamedicaid.com
• LDH Office for Citizens with Developmental Disabilities (OCDD): https://ldh.la.gov/subhome/11
• Louisiana Administrative Code (Title 48): https://www.doa.la.gov/doa/osr/louisiana-administrative-code/

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