reglab/statecodes huggingface dataset:
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 11 - New Opportunities Waiver › Chapter 137 - General Provisions › Section XXI-13705 - Denial of Admission or Discharge Criteria

Current through Register Vol. 50, No. 6, June 20, 2024
A. Individuals shall be denied admission to
				  or discharged from the NOW if one of the following criteria is met:
1. the individual does not meet the financial
				  eligibility requirements for the Medicaid Program;
2. the individual does not meet the
				  requirement for an ICF-IDD level of care;
3. the individual is incarcerated or placed
				  under the jurisdiction of penal authorities, courts or state juvenile
				  authorities;
4. the individual
				  resides in another state or has a change of residence to another
				  state;
5. the beneficiary is
				  admitted to an ICF-IDD facility or nursing facility with the intent to stay and
				  not to return to waiver services. The waiver beneficiary may return to waiver
				  services when documentation is received from the treating physician that the
				  admission is temporary and shall not exceed 90 days. The beneficiary will be
				  discharged from the waiver on the ninety-first day if the beneficiary is still
				  in the ICF-IDD or nursing facility;
6. the health and welfare of the beneficiary
				  cannot be assured through the provision of NOW services within the
				  beneficiary's approved comprehensive plan of care;
7. the individual fails to cooperate in the
				  eligibility determination/re-determination process and in the development or
				  implementation of the approved POC;
8. continuity of services is interrupted as a
				  result of the individual not receiving a NOW service during a period of 30 or
				  more consecutive days. This does not include interruptions in NOW services
				  because of hospitalization, temporary admission to rehabilitation or nursing
				  facilities, or non-routine lapses in services where the family agrees to
				  provide all needed or paid natural supports. There must be documentation from
				  the treating physician that this interruption will not exceed 90 days in the
				  case of the admission to a rehabilitation or nursing facility. During this
				  90-day period, the Office for Citizens with Developmental Disabilities (OCDD)
				  will not authorize payment for NOW services; and/or
9. there is no justification, based on a
				  uniform needs-based assessment and a person-centered planning discussion, that
				  the NOW is the only OCDD waiver that will meet the beneficiary's
				  needs.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 11 - New Opportunities Waiver › Chapter 137 - General Provisions › Section XXI-13706 - Resource Allocation

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				  resource allocation model shall be used to assign service units based on the
				  findings of the needs-based assessment and person-centered planning discussion
				  for individuals who will be offered or are currently receiving New
				  Opportunities Waiver services. Within the resource allocation model, there is a
				  determination of an acuity level for individual and family support (IFS)
				  services.
1. The beneficiary or his/her
				  representative may request a reconsideration and present supporting
				  documentation if he/she disagrees with the amount of assigned IFS service
				  units. If the beneficiary disagrees with the reconsideration decision, he/she
				  may request a fair hearing through the formal appeals process.
2. Implementation of the resource allocation
				  model was phased-in for the allocation of new NOW opportunities and renewal of
				  existing NOW opportunities beginning July 1, 2009.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 11 - New Opportunities Waiver › Chapter 137 - General Provisions › Section XXI-13707 - Programmatic Allocation of Waiver Opportunities

Current through Register Vol. 50, No. 6, June 20, 2024
A. The intellectual/developmental
				  disabilities request for services registry, hereafter referred to as "the
				  registry," is the list that documents and maintains the person's name and
				  protected request date for waiver services. A person's protected request date
				  for any OCDD waiver is the date of the first face-to-face interview in which
				  he/she applied for waiver services and is determined eligible for developmental
				  disabilities services by the entry unit. The order of entry into an OCDD waiver
				  is needs based from the registry arranged by an urgency of need assessment and
				  date of application for developmentally disabled (DD) waiver
				  services.
B. Funded OCDD waiver
				  opportunities shall be offered based on the following priority groups:
1. individuals living at a publicly operated
				  ICF-IDD or who lived at a publicly operated ICF-IDD when it was transitioned to
				  a private ICF-IDD through a cooperative endeavor agreement (CEA facility), or
				  their alternates. Alternates are defined as individuals living in a private
				  ICF-IDD who will give up the private ICF-IDD bed to an individual living at a
				  publicly operated ICF-IDD when it transitioned to a private ICF-IDD through a
				  cooperative endeavor agreement (CEA Facility). Individuals requesting to
				  transition from a publicly operated ICF-IDD are awarded a slot when one is
				  requested, and their health and safety can be assured in an OCDD waiver. This
				  also applies to individuals who were residing in a publicly operated facility
				  at the time the facility was privatized and became a CEA facility. The funded
				  waiver opportunity will be reserved for a period not to exceed 120 days;
				  however, this 120-day period may be extended as needed;
2. individuals on the registry who have a
				  current unmet need as defined by a screening for urgency of need (SUN) score of
				  (three) urgent or (four) emergent and the earliest registry date shall be
				  notified in writing when a funded OCDD waiver opportunity is
				  available.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 11 - New Opportunities Waiver › Chapter 137 - General Provisions › Section XXI-13709 - Emergency Opportunities (Repealed)

Current through Register Vol. 50, No. 6, June 20, 2024
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 36:254 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 11 - New Opportunities Waiver › Chapter 139 - Covered Services › Section XXI-13901 - Individual and Family Support Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. Individual family support (IFS) services
				  are direct support and assistance services, provided in the beneficiary's home
				  or in the community, that allow the beneficiary to achieve and/or maintain
				  increased independence, productivity, enhanced family functioning and inclusion
				  in the community to the same degree as individuals without disabilities. IFS
				  services are also used to provide relief to the primary caregiver.
				  Transportation is included in the reimbursement for these services.
				  Reimbursement for these services includes the development of a service plan for
				  the provision of these services, based on the approved COPC.
1. Individual and family support day (IFS-D)
				  services will be authorized during waking hours for up to 16 hours when natural
				  supports are unavailable in order to provide continuity of services to the
				  beneficiary. Waking hours are the period of time when the beneficiary is awake
				  and not limited to traditional daytime hours as outlined in the CPOC.
a. Additional hours of IFS-D services beyond
				  the 16 hours can be approved based on documented need, which can include
				  medical or behavioral need, and specified in the approved
				  CPOC.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 11 - New Opportunities Waiver › Chapter 139 - Covered Services › Section XXI-13902 - Individual and Family Support Supplemental Payments

Current through Register Vol. 50, No. 6, June 20, 2024
A. Supplemental payments will be made to
				  licensed HCBS providers with a PCA module who support individuals currently
				  receiving qualified waiver services who have complex medical and/or behavioral
				  needs and are at a higher risk of institutionalization.
1. The integration of the supplemental
				  payment provides additional funding to licensed HCBS providers with a PCA
				  module who provide supports that focus on the prevention of deteriorating or
				  worsening medical or behavioral conditions for individuals with complex
				  needs.
2. The provider will be
				  required to complete a screening tool and submit initial documentation as
				  outlined in the program manual prior to qualifying for any supplemental
				  payment. The supplemental payment will be re-evaluated annually to determine
				  ongoing need per program requirements.
3. The PCA providers must be licensed home
				  and community-based services (HCBS) providers with a personal care attendant
				  module in order to receive the supplemental payment, in addition to the
				  criteria listed in
				  §13902 B.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 11 - New Opportunities Waiver › Chapter 139 - Covered Services › Section XXI-13903 - Center-Based Respite Care

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Center-based respite (CBR) care is temporary, shortterm care provided to a
				  beneficiary with developmental disabilities who requires support and/or
				  supervision in his/her day-to-day life due to the absence or relief of the
				  primary caregiver. While receiving center-based respite care, the beneficiary's
				  routine is maintained in order to attend school, work or other community
				  activities/outings. The respite center is responsible for providing
				  transportation for community outings, as that is included as part of its
				  reimbursement.
B. Exclusions
1. Individual family support services (both
				  day and night) may not be provided and will not be reimbursed while the
				  beneficiary is in a center-based respite facility.
2. Monitored in home caregiving, adult
				  companion care, and supported independent living services cannot be reimbursed
				  while the beneficiary is in a center-based respite facility.
3. The cost of room and board cannot be
				  claimed except when provided as part of respite care furnished in a facility
				  approved by the state that is not a private residence.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 11 - New Opportunities Waiver › Chapter 139 - Covered Services › Section XXI-13905 - Community Life Engagement Development

Current through Register Vol. 50, No. 6, June 20, 2024
A. Community life engagement development
				  (CLE) facilitates the development of opportunities to assist beneficiaries in
				  becoming involved in the community through the creation of natural supports.
				  The purpose of CLE is to encourage and foster the development of meaningful
				  relationships in the community reflecting the beneficiary's choices and values.
				  Objectives outlined in the comprehensive plan of care will afford opportunities
				  to increase community inclusion, participation in leisure/recreational
				  activities, and encourage participation in volunteer and civic activities.
				  Reimbursement for this service includes the development of a service plan. To
				  utilize this service, the beneficiary may or may not be present as identified
				  in the approved CLE service plan. CLE services may be performed by a shared
				  supports worker for up to three waiver beneficiaries who have a common direct
				  service provider agency. Rates shall be adjusted accordingly.
B. Transportation costs are included in the
				  reimbursement for CLE services.
C.
				  Service Limitations. Services shall not exceed 60 hours per beneficiary per
				  CPOC year which includes the combination of shared and non-shared community
				  integration development.
D.
				  Provider Qualifications. Providers must be licensed by the Department of Health
				  as a home and community-based services provider and must meet the module
				  specific requirements for the service being provided.
AUTHORITY
					 NOTE: Promulgated in accordance with
					 R.S.
					 36:254 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 11 - New Opportunities Waiver › Chapter 139 - Covered Services › Section XXI-13909 - Substitute Family Care

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Substitute family care (SFC) provides for day programming, transportation,
				  independent living training, community integration, homemaker, chore, attendant
				  care and companion services, and medication oversight (to the extent permitted
				  under state law) to beneficiaries residing in a substitute family care home
				  that meets all licensing requirements for the substitute family care module.
				  The service is a stand-alone family living arrangement for beneficiaries aged
				  18 years and older. The SFC house parents assume the direct responsibility for
				  the beneficiary's physical, social, and emotional well-being and growth,
				  including family ties. Only two SFC beneficiaries may reside in a single SFC
				  setting at the same time. There shall be no more than three persons living in a
				  substitute family care setting who are unrelated to the SFC provider. Immediate
				  family members (mother, father, brother and/or sister) cannot be substitute
				  family care parents. Reimbursement for this service includes the development of
				  a service plan based on the approved CPOC. Beneficiaries living in an SFC home
				  may receive IFS services.
B.
				  Service Limits. SFC services are limited to one service per day.
C. Exclusions
1. Beneficiaries receiving adult companion
				  care services are not eligible to receive substitute family care
				  services.
2. Payments may not be
				  made for room and board, items of comfort or convenience, or the cost of
				  facility maintenance, upkeep, or improvement.
3. Payments may not be made directly or
				  indirectly to members of the beneficiary's immediate family.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 11 - New Opportunities Waiver › Chapter 139 - Covered Services › Section XXI-13911 - Day Habilitation

Current through Register Vol. 50, No. 6, June 20, 2024
A. Day
				  habilitation is provided in a community-based setting and provides the
				  beneficiary assistance with social and adaptive skills necessary to enable the
				  beneficiary to participate as independently as possible in the community. These
				  services focus on socialization with meaningful age-appropriate activities
				  which provide enrichment and promote wellness, as indicated in the
				  beneficiary's CPOC. Day habilitation services are provided in a variety of
				  community settings, (i.e. local recreation department, garden clubs, libraries,
				  etc.) other than the person's residence, except for virtual habilitation
				  services, and are not limited to a fixed-site facility.
1. Day habilitation services must be directed
				  by a person-centered service plan and provide the beneficiary choice in how
				  they spend their day. The activities should assist the beneficiary to gain
				  their desired community living experience, including the acquisition, retention
				  or improvement in self-help, socialization and adaptive skills, and/or to
				  provide the individual an opportunity to contribute to and be a part of his or
				  her community.
2. Day habilitation
				  services shall be coordinated with any therapy, prevocational service, or
				  supported employment models that the beneficiary may be receiving. The
				  beneficiary does not receive payment for the activities in which he/she are
				  engaged. The beneficiary must be 18 years of age or older in order to receive
				  day habilitation services.
3.
				  Career planning activities may be a component of the beneficiary's plan and may
				  be used to develop learning opportunities and career options consistent with
				  the person's skills and interests.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 11 - New Opportunities Waiver › Chapter 139 - Covered Services › Section XXI-13913 - Supported Employment

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Supported employment is competitive work in an integrated work setting, or
				  employment in an integrated work setting in which the beneficiaries are working
				  toward competitive work that is consistent with the strengths, resources,
				  priorities, interests, and informed choice of beneficiaries for whom
				  competitive employment has not traditionally occurred. The beneficiary must be
				  eligible and assessed to need the service in order to receive supported
				  employment services. The outcome of this service is sustained paid employment
				  and work experience leading to further career development and individual
				  integrated community-based employment for which an individual is compensated at
				  or above minimum wage, but not less than the customary wage and level of
				  benefits paid by the employer for the same or similar work performed by
				  individuals without disabilities.
B. Individuals eligible for Louisiana
				  Rehabilitation Services (LRS) must access those services prior to utilizing
				  home and community based waiver supported employment services.
C. Supported employment is conducted in a
				  variety of settings, particularly work sites in which persons without
				  disabilities are employed. Supported employment cannot be provided at worksites
				  that are facility based, or other similar types of vocational services
				  furnished in specialized facilities that are not part of the general workplace.
				  Supported employment includes activities needed by waiver beneficiaries to
				  sustain paid work, including supervision and training and is based on an
				  individualized service plan. Supported employment may include assistance and
				  prompting with:
1. personal hygiene;
2. dressing;
3. grooming;
4. eating;
5. toileting;
6. ambulation or transfers;
7. other personal care and behavioral support
				  needs; and
8. any medical task
				  which can be delegated.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 11 - New Opportunities Waiver › Chapter 139 - Covered Services › Section XXI-13915 - Transportation for Day Habilitation and Supported Employment Models

Current through Register Vol. 50, No. 6, June 20, 2024
A. Transportation
				  provided for the beneficiary to the site of the day habilitation or supported
				  employment model, or between the day habilitation and supported employment
				  model site (if the beneficiary receives services in more than one place) is
				  reimbursable when day habilitation or supported employment model has been
				  provided. Reimbursement may be made for a one-way trip. There is a maximum fee
				  per day that can be charged for transportation regardless of the number of
				  trips per day.
1. Transportation is included
				  in the group supported employment service rate when traveling between job
				  sites.
2. Transportation is a
				  separate billable service if criteria is met. One rate covers regular
				  transportation, and a separate rate covers wheelchair transportation.
3. Transportation may be provided to and/or
				  from the beneficiary's residence or a location agreed upon by the beneficiary
				  or authorized representative to the onsite location or community location and a
				  separate return trip.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 11 - New Opportunities Waiver › Chapter 139 - Covered Services › Section XXI-13917 - Prevocational Services

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Prevocational services are individualized, person centered services that assist
				  the beneficiary in establishing their path to obtain individualized community
				  employment. This service is time limited and targeted for people who have an
				  interest in becoming employed in an individual job in the community but may
				  need additional skills, information and experiences to determine their
				  employment goal and to become successfully employed. Beneficiaries receiving
				  prevocational services may choose to leave this service at any time or pursue
				  employment opportunities at any time.
1. - 2.
				  Repealed.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 11 - New Opportunities Waiver › Chapter 139 - Covered Services › Section XXI-13919 - Environmental Accessibility Adaptations

Current through Register Vol. 50, No. 6, June 20, 2024
A. Environmental accessibility adaptations
				  are physical adaptations to the home or a vehicle that are necessary to ensure
				  the health, welfare, and safety of the beneficiary or that enable him/her to
				  function with greater independence in the home and/or community. Without these
				  services, the beneficiary would require additional supports or
				  institutionalization.
B. Such
				  adaptations may include:
1. installation of
				  ramps and/or grab-bars;
2. widening
				  of doorways;
3. modification of
				  bathroom facilities;
4.
				  installation of specialized electric and plumbing systems which are necessary
				  to accommodate the medical equipment and supplies for the welfare of the
				  beneficiary; or
5. adaptations to
				  the vehicle, which may include a lift or other adaptations, to make the vehicle
				  accessible to the beneficiary or for the beneficiary to drive.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 11 - New Opportunities Waiver › Chapter 139 - Covered Services › Section XXI-13921 - Specialized Medical Equipment and Supplies

Current through Register Vol. 50, No. 6, June 20, 2024
A. Specialized medical equipment and supplies
				  (SMES) are devices, controls, or appliances which enable the participant to:
1. increase his/her ability to perform the
				  activities of daily living;
2.
				  ensure safety; or
3. perceive,
				  control and communicate with the environment in which he/she lives.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 11 - New Opportunities Waiver › Chapter 139 - Covered Services › Section XXI-13923 - Personal Emergency Response Systems

Current through Register Vol. 50, No. 6, June 20, 2024
A. Personal emergency response systems (PERS)
				  is a rented electronic device connected to the person's phone and programmed to
				  signal a response center which enables a beneficiary to secure help in an
				  emergency.
B. Participant
				  Qualifications. Personal emergency response systems (PERS) services are
				  available to those persons who:
1. have a
				  demonstrated need for quick emergency back-up;
2. are unable to use other communication
				  systems as they are not adequate to summon emergency assistance; or
3. do not have 24 hour direct
				  supervision.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 11 - New Opportunities Waiver › Chapter 139 - Covered Services › Section XXI-13925 - Professional Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. Professional
				  services are services designed to increase the beneficiary's independence,
				  participation and productivity in the home, work and community. Beneficiaries,
				  up to the age of 21, who participate in NOW must access these services through
				  the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program.
				  Professional services may only be furnished and reimbursed through NOW when the
				  services are not covered under the Medicaid State Plan. Professional services
				  must be delivered with the beneficiary present and be provided based on the
				  approved CPOC and an individualized service plan. Service intensity, frequency
				  and duration will be determined by individual need. Professional services may
				  be utilized to:
1. perform assessments and/or
				  re-assessments and recommendations;
2. provide consultative services and
				  recommendations;
3. provide
				  training or therapy to a beneficiary and/or his/her natural and formal supports
				  necessary to either develop critical skills that may be self-managed by the
				  beneficiary or maintained according to the beneficiary's needs;
4. intervene in and stabilize a crisis
				  situation, behavioral or medical, that could result in the loss of home and
				  community-based services; or
5.
				  provide necessary information to the beneficiary, family, caregivers and/or
				  team to assist in the implementation of plans according to the approved
				  CPOC.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 11 - New Opportunities Waiver › Chapter 139 - Covered Services › Section XXI-13927 - Skilled Nursing Services

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Skilled nursing services are medically necessary nursing services ordered by a
				  physician and provided by a licensed registered nurse, nurse practitioner, or a
				  licensed practical nurse working under the supervision of a registered nurse.
				  Skilled nursing services shall be provided by a licensed, enrolled home health
				  agency and require an individual nursing service plan. These services must be
				  included in the beneficiary's approved CPOC. All available Medicaid State Plan
				  skilled nursing services must be exhausted before accessing this service.
				  Beneficiaries, up to the age of 21, must access these services as outlined on
				  the CPOC through the Home Health Program in the Medicaid State Plan pursuant to
				  the EPSDT benefit.
B. When there is
				  more than one beneficiary in the home receiving skilled nursing services,
				  services may be shared and payment must be coordinated with the service
				  authorization system and each beneficiary approved CPOC. Nursing consultations
				  are offered on an individual basis only.
C. Provider Qualifications. The provider must
				  be licensed by the Department of Health as a home health agency.
D. Monitored in-home caregiving services
				  cannot be provided at the same time or on the same day as skilled nursing
				  services.
E. All requests for over
				  12 hours of skilled nursing per day must be reviewed and approved by the LDH
				  medical director and medical evaluation team.
AUTHORITY
					 NOTE: Promulgated in accordance with
					 R.S.
					 36:254 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 11 - New Opportunities Waiver › Chapter 139 - Covered Services › Section XXI-13929 - One-Time Transitional Expenses

Current through Register Vol. 50, No. 6, June 20, 2024
A. One-time transitional expenses are those
				  allowable one-time, set-up expenses incurred by beneficiaries who are being
				  transitioned from an ICF-DD to his/her own home or apartment of their choice in
				  the community of their choice.
Own home
shall mean the
				  beneficiary's own place of residence and does not include any family members'
				  home or substitute family care homes. The beneficiaries must be allowed choice
				  in the items purchased.
B.
				  Allowable transitional expenses include:
1.
				  the purchase of essential furnishings, such as:
a. bedroom and living room
				  furniture;
b. dining table and
				  chairs;
c. window blinds;
d. eating utensils; and
e. food preparation items;
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 11 - New Opportunities Waiver › Chapter 139 - Covered Services › Section XXI-13931 - Adult Companion Care

Current through Register Vol. 50, No. 6, June 20, 2024
A. Adult
				  companion care services assist the beneficiary to achieve and/or maintain the
				  outcomes of increased independence, productivity and inclusion in the
				  community. These services are designed for an individual who lives
				  independently and can manage his/her own household with limited supports. The
				  companion is a principal care provider chosen by the beneficiary, who provides
				  services in the beneficiary's home. The companion must be at least 18 years of
				  age and lives with the beneficiary as a roommate. Adult companion care services
				  are furnished through a licensed provider organization as outlined in the
				  beneficiary's CPOC. This service includes:
1.
				  providing assistance with all of the activities of daily living as indicated in
				  the beneficiary's CPOC;
2.
				  providing community integration and coordination of transportation services,
				  including medical appointments; and
3. providing medical and physical health care
				  that can be delivered by unlicensed persons in accordance with Louisiana's
				  Nurse Practice Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 11 - New Opportunities Waiver › Chapter 139 - Covered Services › Section XXI-13933 - Complex Care (Repealed)

Current through Register Vol. 50, No. 6, June 20, 2024
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 36:254 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 11 - New Opportunities Waiver › Chapter 139 - Covered Services › Section XXI-13935 - Housing Stabilization Transition Service

Current through Register Vol. 50, No. 6, June 20, 2024
A. Housing stabilization transition service
				  enables beneficiaries who are transitioning into a permanent supportive housing
				  unit, including those transitioning from institutions, to secure their own
				  housing. The service is provided while the beneficiary is in an institution and
				  preparing to exit the institution using the waiver. The setting for the
				  permanent supportive housing must be integrated in the greater community, and
				  support full access to the greater community by the beneficiary. The service
				  includes the following components:
1.
				  conducting a housing assessment to identify the beneficiary's preferences
				  related to housing (i.e., type, location, living alone or with someone else,
				  accommodations needed, and other important preferences), and his/her needs for
				  support to maintain housing, including:
a.
				  access to housing of the beneficiary's choice, including non-disability
				  specific settings;
b. meeting the
				  terms of a lease;
c. eviction
				  prevention;
d. budgeting for
				  housing/living expenses;
e.
				  obtaining/accessing sources of income necessary for rent;
f. home management;
g. establishing credit; and
h. understanding and meeting the obligations
				  of tenancy as defined in the lease terms;
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 11 - New Opportunities Waiver › Chapter 139 - Covered Services › Section XXI-13937 - Housing Stabilization Service

Current through Register Vol. 50, No. 6, June 20, 2024
A. Housing stabilization service enables
				  waiver participants to maintain their own housing as set forth in the
				  participants approved CPOC. Services must be provided in the home or a
				  community setting. This service includes the following components:
1. conducting a housing assessment to
				  identify the participant's preferences related to housing (i.e., type,
				  location, living alone or with someone else, accommodations needed, and other
				  important preferences), and his/her needs for support to maintain housing,
				  including:
a. access to housing;
b. meeting the terms of a lease;
c. eviction prevention;
d. budgeting for housing/living
				  expenses;
e. obtaining/accessing
				  sources of income necessary for rent;
f. home management;
g. establishing credit; and
h. understanding and meeting the obligations
				  of tenancy as defined in the lease terms;
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 11 - New Opportunities Waiver › Chapter 139 - Covered Services › Section XXI-13939 - Monitored In-Home Caregiving Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. Monitored in-home caregiving (MIHC)
				  services are provided by a principal caregiver to a beneficiary who lives in a
				  private unlicensed residence.
1. The goal of
				  this service is to provide a communitybased option that provides continuous
				  care, supports, and professional oversight.
2. This goal is achieved by promoting a
				  cooperative relationship between a beneficiary, a principal caregiver, the
				  professional staff of a monitored in-home caregiver agency provider, and the
				  beneficiary's support coordinator.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 11 - New Opportunities Waiver › Chapter 139 - Covered Services › Section XXI-13941 - Dental Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. Dental
				  services are available to adult beneficiaries over the age of 21 as of
				  component of the NOW. Covered dental services include:
1. adult diagnostic services;
2. preventative services;
3. restorative services;
4. endodontics;
5. periodontics;
6. prosthodontics;
7. oral and maxillofacial surgery;
8. orthodontics;
9. emergency care; and
10. adjunctive general services.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 11 - New Opportunities Waiver › Chapter 141 - Self-Direction Initiative › Section XXI-14101 - Self-Direction Service Delivery Option

Current through Register Vol. 50, No. 6, June 20, 2024
A. The self-direction initiative is a
				  voluntary, selfdetermination option which allows the beneficiary to coordinate
				  the delivery of NOW services, as designated by OCDD, through an individual
				  direct support professional rather than through a licensed, enrolled provider
				  agency. Selection of this option requires that the beneficiary utilize a
				  payment mechanism approved by the department to manage the required fiscal
				  functions that are usually handled by a provider agency.
B. Beneficiary Responsibilities. Waiver
				  beneficiaries choosing the self-directed service delivery option must
				  understand the rights, risks and responsibilities of managing his/her own care
				  and individual budget. If the beneficiary is unable to make decisions
				  independently, he/she must have an authorized representative who understands
				  the rights, risks and responsibilities of managing his/her care and supports
				  within his/her individual budget. Responsibilities of the beneficiary or
				  authorized representative include:
1.
				  completion of mandatory trainings, including the rights and responsibilities of
				  managing his/her own services and supports and individual budget;
2. participation in the self-direction
				  service delivery option without a lapse in or decline in quality of care or an
				  increased risk to health and welfare; and
a.
				  adhere to the health and welfare safeguards identified by the team, including
				  the application of a comprehensive monitoring strategy and risk assessment and
				  management systems;
3.
				  participation in the development and management of the approved personal
				  purchasing plan:
a. this annual budget is
				  determined by the recommended service hours listed in the beneficiary's CPOC to
				  meet his/her needs;
b. the
				  beneficiary's individual budget includes a potential amount of dollars within
				  which the beneficiary or his/her authorized representative exercises
				  decision-making responsibility concerning the selection of services and service
				  providers.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 11 - New Opportunities Waiver › Chapter 142 - Provider Participation Requirements › Section XXI-14201 - Electronic Visit Verification

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Effective for dates of service on or after August 1, 2015, New Opportunities
				  Waiver providers shall use the electronic visit verification (EVV) system
				  designated by the department for automated scheduling, time and attendance
				  tracking, and billing for certain home and community-based services.
B. Reimbursement shall only be made to
				  providers with documented use of the EVV system. The services that require use
				  of the EVV system will be published in the NOW provider manual.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 36:254 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 11 - New Opportunities Waiver › Chapter 142 - Provider Participation Requirements › Section XXI-14202 - Incident Reporting, Tracking and Follow-Up

Current through Register Vol. 50, No. 6, June 20, 2024
A. The direct service provider is responsible
				  for responding to, reviewing, and remediating incidents that occur to the
				  beneficiaries they support. Direct service providers must comply with any other
				  rules promulgated by the LDH regarding incident reporting and
				  response.
AUTHORITY
					 NOTE: Promulgated in accordance with
					 R.S.
					 36:254 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 11 - New Opportunities Waiver › Chapter 143 - Reimbursement › Section XXI-14301 - Unit of Reimbursement

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Reimbursement for services shall be a prospective flat rate for each approved
				  unit of service provided to the beneficiary. One-quarter hour (15 minutes) is
				  the standard unit of service and reimbursement shall not be made for less than
				  15 minutes (one-quarter hour) of service. This covers both service provision
				  and administrative costs for the following services:
1. center-based respite;
2. community integration development:
a. up to three beneficiaries may choose to
				  share community integration development if they share a common provider of this
				  service;
b. there is a separate
				  reimbursement rate for community integration development when these services
				  are shared;
3. day
				  habilitation;
4. prevocational
				  services;
5. individual and family
				  support-day and night:
a. up to three
				  beneficiaries may choose to share individualized and family support services if
				  they share a common provider;
b.
				  there is a separate reimbursement rate for individualized and family support
				  when these services are shared;
6. professional services;
7. skilled nursing services:
a. up to three beneficiaries may choose to
				  share skilled nursing services if they share a common provider;
b. there is a separate reimbursement rate for
				  skilled nursing services when these services are shared;
c. nursing consultations are offered on an
				  individual basis only.
d. - e.
				  Repealed.
8. supported
				  employment;
9. housing
				  stabilization transition; and
10.
				  housing stabilization.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 13 - Residential Options Waiver › Chapter 161 - General Provisions › Section XXI-16101 - Introduction

Current through Register Vol. 50, No. 6, June 20, 2024
A. The Residential
				  Options Waiver (ROW), a 1915(c) home and community-based services (HCBS)
				  waiver, is designed to assist beneficiaries in leading healthy, independent and
				  productive lives to the fullest extent possible and promote the full exercise
				  of their rights as citizens of the state of Louisiana. The ROW is
				  personcentered incorporating the beneficiary's support needs and preferences
				  with a goal of integrating the beneficiary into their community. The ROW
				  provides opportunities for eligible individuals with developmental disabilities
				  to receive HCBS services that allow them to transition to and/or remain in the
				  community. These individuals would otherwise require an intermediate care
				  facility for individuals with intellectual disabilities (ICF/IID) level of
				  care.
B. The Residential Options
				  Waiver services are provided with the goal of promoting independence through
				  strengthening the beneficiary's capacity for self-care, selfsufficiency and
				  community integration utilizing a wide array of services, supports and
				  residential options. The ROW is person-centered incorporating the beneficiary's
				  support needs and preferences, while supporting the dignity, quality of life,
				  and security with the goal of integrating the participant into the
				  community.
AUTHORITY
					 NOTE: Promulgated in accordance with
					 R.S.
					 36:254 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 13 - Residential Options Waiver › Chapter 161 - General Provisions › Section XXI-16103 - Program Description

Current through Register Vol. 50, No. 6, June 20, 2024
A. The ROW
				  is designed to utilize the principles of self-determination and to supplement
				  the family and/or community supports that are available to maintain the
				  individual in the community and are designed to allow an individual experience
				  that mirrors the experiences of individuals without disabilities. These
				  services are not to be restrictive, but liberating, by empowering individuals
				  to experience life in the most fulfilling manner as defined by the individual
				  while still assuring health and safety. In keeping with the principles of
				  self-determination, ROW includes a self-direction option, which allows for
				  greater flexibility in hiring, training and general service delivery issues.
				  ROW services are meant to enhance, not replace existing informal
				  networks.
B. The ROW offers an
				  alternative to institutional care with the objectives to:
1. promote independence for beneficiaries
				  through the provision of services meeting the highest standards of quality and
				  national best practices, while ensuring health and safety through a
				  comprehensive system of beneficiary safeguards;
2. offer an alternative to
				  institutionalization and costly comprehensive services through the provision of
				  an array of services and supports that promote community inclusion and
				  independence by enhancing and not replacing existing informal networks;
				  and
3. offer access to services
				  which would protect the health and safety of the beneficiary.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 13 - Residential Options Waiver › Chapter 161 - General Provisions › Section XXI-16104 - Settings for Home and Community Based Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. ROW beneficiaries are expected to be
				  integrated in and have full access to the greater community while receiving
				  services, to the same extent as individuals without disabilities. Providers
				  shall meet the requirements of the U.S. Department of Health and Human
				  Services, Centers for Medicare and Medicaid Services (CMS) home and
				  community-based setting requirements for home and community-based services
				  (HCBS) waivers as delineated in LAC 50:XXI.901 or any superseding
				  rule.
AUTHORITY
					 NOTE: Promulgated in accordance with
					 R.S.
					 36:254 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 13 - Residential Options Waiver › Chapter 161 - General Provisions › Section XXI-16105 - Beneficiary Qualifications

Current through Register Vol. 50, No. 6, June 20, 2024
A. In
				  order to qualify for Residential Options Waiver (ROW), individuals of all ages
				  must meet all of the following criteria:
1.
				  have an intellectual and/or developmental disability as specified in
				  R.S.
				  28:451.2;
2. be determined eligible through the
				  developmental disabilities entry process;
3. be on the intellectual/developmental
				  disabilities (IDD) request for services registry (RFSR), unless otherwise
				  specified through programmatic allocation in
				  §16107 of this Chapter;
4. meet the requirements for an ICF/IID level
				  of care which requires active treatment for developmental disabilities under
				  the supervision of a qualified developmental disabilities
				  professional;
5. meet the financial
				  eligibility requirements for the Louisiana Medicaid Program;
6. have justification based on a uniform
				  needs-based assessment and a person-centered planning discussion that the ROW
				  is the OCDD waiver that will meet the needs of the individual;
7. be a resident of Louisiana;
8. be a citizen of the United States or a
				  qualified alien; and
9. have
				  assurance that health and welfare of the individual can be maintained in the
				  community with the provision of the ROW services.