reglab/statecodes huggingface dataset:
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 7 - Community Choices Waiver › Chapter 85 - Self-Direction Initiative › Section XXI-8501 - Self-Direction Service Option

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				  self-direction initiative is a voluntary, self-determination option which
				  allows the participant to coordinate the delivery of personal assistance
				  services through an individual direct support professional rather than through
				  a licensed, enrolled provider. Selection of this option requires that the
				  participant utilize a payment mechanism approved by the department to manage
				  the required fiscal functions that are usually handled by a traditional direct
				  service provider.
B. Participant
				  Responsibilities. Waiver participants choosing the self-directed services
				  option must understand the rights, risks, and responsibilities of managing
				  their own care and individual budget. If the participant is unable to make
				  decisions independently, he/she must have a responsible representative who
				  understands the rights, risks, and responsibilities of managing his/her care
				  and supports within his/her individual budget.
C. Termination of the Self-Direction Service
				  Option. Termination of participation in the self-direction service option
				  requires a revision of the POC, the elimination of the fiscal agent and the
				  selection of the Medicaid-enrolled waiver service provider(s) of choice.
1. Voluntary Termination. A waiver
				  participant may choose at any time to withdraw from the self-direction service
				  option and return to the traditional direct service provider.
2. Involuntary Termination. The department
				  may terminate the self-direction service option for a participant and require
				  him/her to receive provider-managed services under the following circumstances:
a. the health or welfare of the participant
				  is compromised by continued participation in the self-directed
				  option;
b. the participant is no
				  longer able to direct his/her own care and there is no responsible
				  representative to direct the care;
c. there is misuse of public funds by the
				  participant or the responsible representative; or
d. the participant or responsible
				  representative:
i. places barriers to the
				  payment of the salaries and related state and federal payroll taxes of direct
				  support staff;
ii. fails to follow
				  the POC;
iii. fails to provide
				  required documentation;
iv. fails
				  to cooperate with the department, fiscal agent or support
				  coordinator;
v. violates Medicaid
				  Program rules or guidelines of the self-direction option; or
vi.fails to receive self-directed services
				  for 90 calendar days or more.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 7 - Community Choices Waiver › Chapter 86 - Organized Health Care Delivery System › Section XXI-8601 - General Provisions

Current through Register Vol. 50, No. 6, June 20, 2024
A. An
				  organized health care delivery system (OHCDS) is an entity with an identifiable
				  component within its mission to provide services to individuals receiving
				  Community Choices Waiver services. The entity must be a qualified and enrolled
				  Medicaid provider and must directly render at least one service offered in the
				  Community Choices Waiver. As long as the entity furnishes at least one waiver
				  service itself, it may contract with other qualified providers to furnish the
				  other required waiver services.
B.
				  Entities that function as an OHCDS must ensure that subcontracted entities meet
				  all of the applicable provider qualification standards for the services they
				  are rendering.
C. The OHCDS must
				  attest that all applicable provider qualifications are met.
D. Prior to enrollment, an OHCDS must show
				  the ability to provide all of the following Community Choices Waiver services:
1. personal assistance services
				  (PAS);
2. home delivered
				  meals;
3. skilled maintenance
				  therapy;
4. nursing;
5. caregiver temporary support
				  services;
6. assistive devices and
				  medical supplies;
7. environmental
				  accessibility adaptations (EAA); and
8. adult day health care (only if there is a
				  licensed ADHC provider in the service area).
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 7 - Community Choices Waiver › Chapter 87 - Plan of Care › Section XXI-8701 - Plan of Care

Current through Register Vol. 50, No. 6, June 20, 2024
A. The applicant
				  and support coordinator have the flexibility to construct a plan of care that
				  serves the participant's health and welfare needs. The service package provided
				  under the POC shall include services covered under the Community Choices Waiver
				  in addition to services covered under the Medicaid state plan (not to exceed
				  the established service limits for either waiver or state plan services) as
				  well as other services, regardless of the funding source for these services.
				  All services approved pursuant to the POC shall be medically necessary and
				  provided in a cost-effective manner. The POC shall be developed using a
				  person-centered process coordinated by the support coordinator.
B. Reimbursement shall not be made for
				  services provided prior to the departments, or its designees, approval of the
				  POC.
C. The support coordinator
				  shall complete a POC which shall contain the:
1. types and number of services (including
				  waiver and all other services) necessary to reasonably assure health and
				  welfare and to maintain the person in the community;
2. individual cost of each waiver service;
				  and
3. total cost of waiver
				  services covered by the POC.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 7 - Community Choices Waiver › Chapter 89 - Admission and Discharge Criteria › Section XXI-8901 - Admission Criteria

Current through Register Vol. 50, No. 6, June 20, 2024
A. Admission to
				  the Community Choices Waiver program shall be determined in accordance with the
				  following criteria:
1. meets the target
				  population criteria as specified in the approved waiver document;
2. initial and continued Medicaid
				  eligibility;
3. initial and
				  continued eligibility for a nursing facility level of care;
4. justification, as documented in the
				  approved POC, that the Community Choices Waiver services are appropriate, cost
				  effective and represent the least restrictive environment for the individual;
				  and
5. reasonable assurance that
				  the health and welfare of the participant can be maintained in the community
				  with the provision of Community Choices Waiver services.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 7 - Community Choices Waiver › Chapter 89 - Admission and Discharge Criteria › Section XXI-8903 - Admission Denial or Discharge Criteria

Current through Register Vol. 50, No. 6, June 20, 2024
A. Admission shall be denied or the
				  participant shall be discharged from the Community Choices Waiver program if
				  any of the following conditions are determined.
1. The individual does not meet the target
				  population criteria as specified in the federally approved waiver
				  document.
2. The individual does
				  not meet the criteria for Medicaid financial eligibility.
3. The individual does not meet the criteria
				  for nursing facility level of care.
4. The participant resides in another state
				  or has a change of residence to another state.
5. Continuity of services is interrupted as a
				  result of the participant not receiving and/or refusing Community Choices
				  Waiver services (exclusive of support coordination services) for a period of 30
				  consecutive days.
EXCEPTION: An exception may be granted by OAAS to delay
					 discharge if interruption is due to an acute care hospital, rehabilitation
					 hospital, or nursing facility admission.
6. The health and welfare of the individual
				  cannot be reasonably assured through the provision of Community Choices Waiver
				  services.
7. The individual fails
				  to cooperate in the eligibility determination or plan of care development
				  processes or in the performance of the POC.
8. Failure on behalf of the individual to
				  maintain a safe and legal environment.
9. It is not cost effective or appropriate to
				  serve the individual in the Community Choices Waiver.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 7 - Community Choices Waiver › Chapter 91 - Waiver Cost Neutrality › Section XXI-9101 - Waiver Costs Limit

Current through Register Vol. 50, No. 6, June 20, 2024
A. The annual
				  service budget for each of the RUG-III/HC groups shall be reviewed to ensure
				  that the costs of the Community Choices Waiver remain within applicable federal
				  rules regarding the cost-effectiveness of the waiver. To ensure
				  cost-effectiveness, the mean expenditures across all RUG-III/HC categories must
				  be less than or equal to the average cost to the state of providing care in a
				  nursing facility. If the waiver is not cost-effective, the annual service
				  budgets for some or all RUG-III/HC groups shall be reduced to bring the waiver
				  into compliance.
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 7 - Community Choices Waiver › Chapter 93 - Provider Responsibilities › Section XXI-9301 - General Provisions

Current through Register Vol. 50, No. 6, June 20, 2024
A. Any
				  provider of services under the Community Choices Waiver shall abide by and
				  adhere to any federal or state laws, rules, policy, procedures, or manuals
				  issued by the department. Failure to do so may result in sanctions.
B. The provider shall not request payment
				  unless the participant for whom payment is requested is receiving services in
				  accordance with the Community Choices Waiver program provisions and the
				  services have been prior authorized and actually provided.
C. Any provider of services under the
				  Community Choices Waiver shall not refuse to serve any individual who chooses
				  their agency unless there is documentation to support an inability to meet the
				  individual's health and welfare needs, or all previous efforts to provide
				  service and supports have failed and there is no option but to refuse services.
1. OAAS or its designee must be immediately
				  notified of the circumstances surrounding a refusal by a provider to render
				  services.
2. This requirement can
				  only be waived by OAAS or its designee.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 7 - Community Choices Waiver › Chapter 93 - Provider Responsibilities › Section XXI-9303 - Reporting Requirements

Current through Register Vol. 50, No. 6, June 20, 2024
A. Support
				  coordinators and direct service providers are obligated to immediately report
				  any changes to the department that could affect the waiver participant's
				  eligibility including, but not limited to, those changes cited in the denial or
				  discharge criteria.
B. Support
				  coordinators and direct service providers are responsible for documenting the
				  occurrence of incidents or accidents that affect the health and welfare of the
				  participant and for completing an incident report. The incident report shall be
				  submitted to the department or its designee with the specified requirements
				  within specified timelines.
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 7 - Community Choices Waiver › Chapter 95 - Reimbursement › Section XXI-9501 - Reimbursement and Rate Requirements

Current through Register Vol. 50, No. 6, June 20, 2024
A. Reimbursement for the following services
				  shall be a prospective flat rate for each approved unit of service provided to
				  the participant. One quarter hour (15 minutes) is the standard unit of service,
				  which covers both the service provision and administrative costs for the
				  following services, and reimbursement shall not be made for less than one
				  quarter hour (15 minutes) of service:
1.
				  personal assistance services (except for the "a.m. and p.m." service delivery
				  model);
a. up to three participants may share
				  personal assistance services if they live together and share a common provider
				  of these services; and
b. there is
				  a separate reimbursement rate for shared personal assistance
				  services;
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 7 - Community Choices Waiver › Chapter 95 - Reimbursement › Section XXI-9503 - Direct Support/Service Worker Wages, Other Benefits, and Workforce Retention Bonus Payments

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Establishment of Direct Support/Service Worker Wage Floor and Other Benefits
1. Personal assistance service (PAS)
				  providers that were providing services on or after October 1, 2021 and
				  employing direct service workers (DSWs) will receive the equivalent of a $5.50
				  per hour rate increase.
2. DSWs
				  providing self-direction PAS on or after July 31, 2022 shall be paid a minimum
				  wage floor of $9 per hour.
3. Adult
				  day health care (ADHC) providers that were providing ADHC services on or after
				  October 1, 2021 and employing ADHC direct support workers will receive a rate
				  increase. The ADHC reimbursement rates shall be rebased resulting in an average
				  increase of $4.31 per hour (rates differ based on facility specific
				  transportation rate).
4. All PAS
				  and ADHC providers affected by this rate increase shall be subject to passing
				  70 percent of their rate increases directly to the direct support/service
				  worker in various forms. These forms include a minimum wage floor of $9 per
				  hour and other wage and non-wage benefits. This wage floor and wage and
				  non-wage benefits are effective for all affected direct support/service workers
				  of any working status, whether full-time or part-time.
5. The rate increase, wage floor and/or wage
				  and non-wage benefits will end March 31, 2025 or when the state's funding
				  authorized under section 9817 of the American Rescue Plan Act of 2021 (Pub. L.
				  No. 117-002) is exhausted.
6. The
				  Department of Health (LDH) reserves the right to adjust the direct
				  support/service worker wage floor and/or wage and non-wage benefits as needed
				  through appropriate rulemaking promulgation consistent with the Administrative
				  Procedure Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 9 - Children's Choice Waiver › Chapter 111 - General Provisions › Section XXI-11101 - Introduction

Current through Register Vol. 50, No. 6, June 20, 2024
A. The Children's
				  Choice (CC) Waiver is a home and community-based services (HCBS) program that
				  offers supplemental support to individuals with intellectual/developmental
				  disabilities (IDD) who currently live in the community or who will leave an
				  institution to return to the community.
B. The Children's Choice Waiver is an option
				  offered to individuals who have been determined eligible for developmental
				  disability services and are on the intellectual/developmental disabilities
				  request for services registry (IDDRFSR) hereafter referred to as "the registry"
				  or as identified in
				  §11105 or §11107
C. Children's Choice Waiver participants are
				  eligible for all medically necessary Medicaid services in addition to
				  Children's Choice Waiver services.
D. The number of participants in the
				  Children's Choice Waiver is contingent upon available funding.
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 9 - Children's Choice Waiver › Chapter 111 - General Provisions › Section XXI-11103 - Participant Qualifications and Admissions Criteria

Current through Register Vol. 50, No. 6, June 20, 2024
A. The Children's Choice Waiver is available
				  to individuals who:
1. are from birth through
				  age 20;
2. have a developmental
				  disability as specified in
				  R.S.
				  28:451.2;
3. are on the registry unless otherwise
				  specified in
				  §11105 and §11107;
4. meet all of the financial and
				  non-financial Medicaid eligibility criteria for a home and community-based
				  services (HCBS) waiver;
5. meet the
				  requirements for an intermediate care facility for persons with
				  intellectual/developmental disabilities (ICF/ID) level of care, which requires
				  active treatment of a developmental disability under the supervision of a
				  qualified developmental disability professional;
6. meet the assurance requirements that the
				  health and welfare of the individual can be maintained in the community with
				  the provision of children's choice services;
7. have justification, as documented in the
				  approved plan of care, that the children's choice services are appropriate,
				  cost effective and represent the least restrictive environment for the
				  individual;
8. are residents of
				  Louisiana; and
9. are citizens of
				  the United States or a qualified alien.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 9 - Children's Choice Waiver › Chapter 111 - General Provisions › Section XXI-11104 - Admission Denial or Discharge Criteria

Current through Register Vol. 50, No. 6, June 20, 2024
A. Individuals shall be denied admission to
				  or discharged from the Children's Choice Waiver 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
				  requirements for ICF/ID 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 participant is
				  admitted to an ICF/ID or nursing facility with the intent to stay and not to
				  return to waiver services:
a. The waiver
				  participant may return to waiver services when documentation is received from
				  the treating physician that the admission is temporary and shall not exceed 90
				  days.
b. the participant will be
				  discharged from the waiver on the ninety-first day if the participant is still
				  in the ICF/ID or nursing facility;
6. the health and welfare of the individual
				  cannot be assured through the provision of children's choice services within
				  the individual's approved 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 plan of care;
8. Repealed.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 9 - Children's Choice Waiver › Chapter 111 - General Provisions › Section XXI-11105 - Money Follows the Person Rebalancing Demonstration

Current through Register Vol. 50, No. 6, June 20, 2024
A. The Money Follows the Person (MFP)
				  Rebalancing Demonstration is a federal demonstration program awarded by the
				  Centers for Medicare and Medicaid Services to the department. The demonstration
				  is a transition program that targets individuals using qualified institutional
				  services and moves them to home and community-based long-term care services.
				  The MFP rebalancing demonstration will stop allocation of opportunities when
				  the demonstration expires.
1. For purposes of
				  these provisions, a qualified institution is a hospital, nursing facility, or
				  intermediate care facility for people with developmental
				  disabilities.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 9 - Children's Choice Waiver › Chapter 111 - General Provisions › Section XXI-11107 - Allocation of Waiver Opportunities

Current through Register Vol. 50, No. 6, June 20, 2024
A. The intellectual/developmental
				  disabilities (I/DD) request for services registry, hereafter referred to as
				  "the registry," shall be used to identify individuals with intellectual and/or
				  developmental disabilities who are waiting for an OCDD waiver opportunity.
1. - 1.b. Repealed.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 9 - Children's Choice Waiver › Chapter 113 - Service › Section XXI-11301 - Service Cap

Current through Register Vol. 50, No. 6, June 20, 2024
A. Effective May
				  20, 2007, children's choice services are capped at $17,000 per individual per
				  plan of care year.
B. Participants
				  are eligible to receive all medically necessary Medicaid State Plan services,
				  including early periodic screening, diagnosis, and treatment (EPSDT)
				  services.
C. Effective September 1,
				  2010, children's choice waiver services are capped at $16,660 per individual
				  per plan of care year.
D. Effective
				  August 1, 2012, children's choice services are capped at $16,410 per individual
				  per plan of care year.
E.
				  Children's choice services are capped at $20,200 per individual per plan of
				  care year.
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 9 - Children's Choice Waiver › Chapter 113 - Service › Section XXI-11303 - Service Definitions

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				  services in this
				  §11303 are included in the service
				  package for the Children's Choice Waiver. All services must be included on the
				  approved plan of care which prior authorizes all services.
1. Childrens choice services may be utilized
				  to supplement EPSDT State Plan services that are prior approved as medically
				  necessary.
2. Childrens choice
				  family supports services cannot be provided on the same day at the same time as
				  EPSDTs personal care services.
3.
				  Childrens choice family supports services cannot be provided on the same day at
				  the same time as any other childrens choice waiver service except for the
				  following:
a. environmental accessibility
				  adaptations;
b. family
				  training;
c. specialized medical
				  equipment and supplies; or
d.
				  support coordination.
4.
				  Childrens choice services cannot be provided in a school setting.
5. Services provided through a program funded
				  under the Individuals with Disabilities Education Act (IDEA) must be utilized
				  before accessing childrens choice therapy services.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 9 - Children's Choice Waiver › Chapter 115 - Provider Participation Requirements › Subchapter A - Provider Qualifications › Section XXI-11501 - Support Coordination Providers and Service Providers

Current through Register Vol. 50, No. 6, June 20, 2024
A. Support Coordination Providers. Families
					 of waiver participants shall choose one support coordination agency from those
					 available in their region to provide developmental disabilities support
					 coordination services.
B. Service
					 Providers. Agencies licensed to provide personal care attendant services may
					 enroll as a provider of children's choice services with the exception of
					 support coordination services and therapy services. Agencies that enroll to be
					 a children's choice service provider shall provide family support services, and
					 shall either provide or subcontract for center-based respite, environmental
					 accessibility adaptations, family training, and specialized medical equipment
					 and supplies. Families of participants shall choose one service provider agency
					 from those available in their region that will provide all waiver services,
					 except support coordination.
1. Family
					 members who provide family support services must meet the same standards of
					 service, training requirements, and documentation requirements as caregivers
					 who are unrelated to the participant.
2. Legally responsible individuals (such as a
					 parent or spouse) and legal guardians who provide family support services for
					 their own child must meet the same standards of service, training requirements,
					 and documentation requirements as caregivers who are unrelated to the
					 participant. Monitoring shall be conducted to ensure proper documentation and
					 that the services are delivered in accordance with the child's plan of care.
					 Payments to legally responsible individuals, legal guardians and family members
					 living in the home shall be audited on a semi-annual basis to ensure payment
					 for services rendered.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 9 - Children's Choice Waiver › Chapter 115 - Provider Participation Requirements › Subchapter B - Provider Requirements › Section XXI-11521 - General Requirements for Medicaid Enrollment

Current through Register Vol. 50, No. 6, June 20, 2024
A. In order to participate in the Medicaid
					 Program, a provider must meet all of the following requirements.
1. The provider must meet all the
					 requirements for licensure as established by state laws and rules promulgated
					 by the Department of Health (LDH) or have a current, valid license or
					 certification from the appropriate governing board for that profession.
2. The provider must agree to
					 comply with all the terms and conditions for Medicaid enrollment as contained
					 in:
a. the provider enrollment
					 packet;
b. the Medical Assistance
					 Program Integrity Law (MAPIL),
					 R.S.
					 46:437.1-440.3;
c. the provider agreement;
d. the standards for participation contained
					 in the Children's Choice and Case Management Services provider manuals;
					 and
e. all other applicable federal
					 and state laws, regulations and policies.
3. All services must be appropriately
					 documented in the provider's records.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 9 - Children's Choice Waiver › Chapter 115 - Provider Participation Requirements › Subchapter B - Provider Requirements › Section XXI-11525 - Case Management Providers

Current through Register Vol. 50, No. 6, June 20, 2024
A.
					 Case management providers must also comply with Paragraphs 1 and 2 of this
					 Subsection A in order to participate as children choice providers.
1. Providers of case management services for
					 the Children's Choice program must have a contract with LDH to provide services
					 to waiver participants.
2. Case
					 management agencies must meet all requirements of their contract in addition to
					 the requirements contained in the Children's Choice and Case Management
					 Services Provider Manuals.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 9 - Children's Choice Waiver › Chapter 115 - Provider Participation Requirements › Subchapter B - Provider Requirements › Section XXI-11529 - Professional Services Providers

Current through Register Vol. 50, No. 6, June 20, 2024
A.
					 Professional services are direct services to participants, based on need, that
					 may be utilized to increase the participants independence, participation and
					 productivity in the home and community. Service intensity, frequency and
					 duration will be determined by individual need. Professional services include
					 the following:
1. aquatic therapy;
2. art therapy;
3. music therapy;
4. sensory integration; and
5. hippotherapy/therapeutic horseback
					 riding.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 9 - Children's Choice Waiver › Chapter 115 - Provider Participation Requirements › Subchapter B - Provider Requirements › Section XXI-11531 - 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, Childrens Choice
					 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 Childrens Choice Waiver provider
					 manual.
Office for Citizens with Developmental Disabilities, LR
						41:1286 (July 2015).
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 9 - Children's Choice Waiver › Chapter 117 - Crisis Provisions › Section XXI-11701 - Participation in Children's Choice

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Children's Choice Waiver participants who experience a crisis that increases
				  the need for paid supports to a level that cannot be accommodated within the
				  service cap specified in
				  §11301. A on waiver
				  expenditures, may request consideration for a crisis designation. A
crisis
is defined as a catastrophic change in circumstances
				  rendering the natural and community support system unable to provide for the
				  health and welfare of the participant at the level of benefits offered under
				  Children's Choice. The procedure in this Chapter has been developed to address
				  these situations.
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 9 - Children's Choice Waiver › Chapter 117 - Crisis Provisions › Section XXI-11703 - Crisis Designation Criteria

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  In order to be considered a crisis, one of the following circumstances must
				  exist:
1. death of the caregiver with no
				  other supports (i.e., other family) available; or
2. the caregiver is incapacitated with no
				  other supports (i.e., other family) available; or
3. the participant is committed to the
				  custody of LDH by the court; or
4.
				  other family crisis with no caregiver support available, such as abuse/neglect,
				  or a second person in the household becomes disabled and must be cared for by
				  same caregiver, causing inability of the natural caregiver to continue
				  necessary supports to assure health and safety; or
5. the participant's condition deteriorates
				  to the point when the plan of care is inadequate.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 9 - Children's Choice Waiver › Chapter 117 - Crisis Provisions › Section XXI-11705 - Crisis Extension Provisions

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Additional services (crisis support) outside of the waiver cap amount shall be
				  approved by the OCDD state office. Crisis designation is time-limited,
				  depending on the anticipated duration of the causative event. Each request for
				  crisis designation may be approved for a maximum of three months.
B. Repealed.
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 9 - Children's Choice Waiver › Chapter 119 - Noncrisis Provisions › Section XXI-11901 - General Provisions (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 9 - Children's Choice Waiver › Chapter 119 - Noncrisis Provisions › Section XXI-11903 - Good Cause (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 9 - Children's Choice Waiver › Chapter 119 - Noncrisis Provisions › Section XXI-11905 - Determination Responsibilities and Appeals

Current through Register Vol. 50, No. 6, June 20, 2024
A. The LGE shall have the responsibility for
				  making the determinations as to the matters set forth in this Chapter 119.
				  Persons who have elected or whose legal representatives have elected that they
				  receive services under the Children's Choice Waiver have the right to appeal
				  any determination of the department as to matters set forth in this Chapter
				  119, under the regulations and procedures applicable to Medicaid fair
				  hearings.
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 9 - Children's Choice Waiver › Chapter 121 - Reimbursement Methodology › Section XXI-12101 - Unit of Reimbursement

Current through Register Vol. 50, No. 6, June 20, 2024
A. Case
				  management services shall be reimbursed at a flat monthly rate billed for each
				  waiver participant served in accordance with the conditions and procedures
				  contained in the Case Management Services provider manual.
1. Establishment of Support Coordination
				  Workforce Bonus Payments
a. Support
				  coordination providers who provided services from April 1, 2021 to October 31,
				  2022 shall receive bonus payments of $300 per month for each support
				  coordination worker that worked with participants for those months.
b. The support coordination worker who
				  provided services to participants from April 1, 2021 to October 31, 2022 must
				  receive at least $250 of this $300 bonus payment paid to the provider. This
				  bonus payment is effective for all eligible support coordination workers of any
				  working status, whether full-time or part-time.
c. Repealed.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 9 - Children's Choice Waiver › Chapter 123 - Self-Direction Initiative › Section XXI-12301 - Self-Direction Service Delivery Option

Current through Register Vol. 50, No. 6, June 20, 2024
A. The self-direction initiative is a
				  voluntary, self-determination option which allows the participant to coordinate
				  the delivery of children's choice 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 participant utilize
				  a payment mechanism approved by the department to manage the required fiscal
				  functions that are usually handled by a provider agency.
B. Participant Responsibilities. Waiver
				  participants choosing the self-directed service delivery option must understand
				  the rights, risks and responsibilities of managing their own care and
				  individual budget. If the participant is under 18 years of age or is unable to
				  make decisions independently, the participant must have an authorized
				  representative who understands the rights, risks and responsibilities of
				  managing his/her care and supports within the participant's individual budget.
				  The employer must be at least 18 years of age. Responsibilities of the
				  participant or authorized representative include:
1. completion of mandatory trainings,
				  including the rights and responsibilities of managing services, supports and
				  individual budgets;
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;
a. adhering 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 budget:
a. this annual budget is determined by the
				  recommended service hours listed in the participant's plan of care to meet
				  his/her needs; and
b. the
				  participant's individual budget includes a potential amount of dollars within
				  which the participant or his/her authorized representative exercises
				  decision-making responsibility concerning the selection of services and service
				  providers;
c. Repealed.
4. all services rendered shall be
				  prior approved and in accordance with the plan of care;
5. all services must be documented in service
				  notes, which describes the services rendered and progress towards the
				  participant's personal outcomes plan of care; and
6. authorized representatives may be the
				  employer of the self-directed option, but may not also be the
				  employee.
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-13701 - Introduction

Current through Register Vol. 50, No. 6, June 20, 2024
A. The New
				  Opportunities Waiver (NOW), hereafter referred to as the NOW, is designed to
				  enhance the home and community-based services and supports available to
				  individuals with developmental disabilities, who would otherwise require an
				  intermediate care facility for persons with developmental disabilities
				  (ICF-IDD) level of care. The mission of the NOW is to utilize the principle of
				  selfdetermination and supplement the family and/or community supports while
				  supporting the dignity, quality of life and security in the everyday life of an
				  individual, and maintaining that individual in the community. Services provided
				  in the NOW are community-based, 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, NOW includes a self-direction service
				  delivery option. This allows for greater flexibility in hiring, training, and
				  general service delivery issues.
B.
				  All NOW services are accessed through the case management agency of the
				  beneficiary's choice. All services must be prior authorized and delivered in
				  accordance with the approved comprehensive plan of care (CPOC). The CPOC shall
				  be developed using a person-centered process coordinated by the beneficiary's
				  case manager.
C. Providers must
				  maintain adequate documentation to support service delivery and compliance with
				  the approved plan of care and provide said documentation at the request of the
				  department.
D. In order for the NOW
				  provider to bill for services, the beneficiary and the direct service provider,
				  professional or other practitioner rendering service, must be present at the
				  time the service is rendered unless otherwise allowed in rule. The service must
				  be documented in service notes describing the service rendered and progress
				  towards the beneficiary's personal outcomes and CPOC.
E. Only the following NOW services shall be
				  provided for, or billed for, during the same hours on the same day as any other
				  NOW service:
1. substitute family
				  care;
2. supported independent
				  living; and
3. skilled nursing
				  services.
a. Skilled nursing services may
				  only be provided with:
i. substitute family
				  care;
ii. supported independent
				  living;
iii. day
				  habilitation;
iv. supported
				  employment (all three modules); and/or
v. prevocational services
4. - 4.e.
				  Repealed.
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-13702 - Settings for Home and Community-Based Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. NOW 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.
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 137 - General Provisions › Section XXI-13703 - Beneficiary Qualifications and Admissions Criteria

Current through Register Vol. 50, No. 6, June 20, 2024
A. In order to qualify for the New
				  Opportunities Waiver (NOW), an individual must be three years of age or older
				  and meet all of the following criteria:
1.
				  have an intellectual and/or developmental disability as specified in
				  R.S.
				  28:451.2;
2. be deemed eligible for developmental
				  disability services and be on the intellectual/developmental disabilities (IDD)
				  request for services registry (RFSR), unless otherwise specified through
				  programmatic allocation in §13707;
3. meet the financial eligibility
				  requirements for the Medicaid Program;
4. meet the requirements for an ICF-IDD level
				  of care which requires active treatment of a developmental disability under the
				  supervision of a qualified developmental disability professional;
5. have assurance that health and welfare of
				  the individual can be maintained in the community with the provision of NOW
				  services;
6. have 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 needs of the
				  individual;
7. be a resident of
				  Louisiana; and
8. be a citizen of
				  the United States or a qualified immigrant.
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-13704 - Needs-Based Assessment

Current through Register Vol. 50, No. 6, June 20, 2024
A. A
				  uniform needs-based assessment in conjunction with person-centered planning is
				  utilized in the service planning process for the individuals receiving or
				  participating in an OCDD waiver. The results of this assessment activity shall
				  be utilized to determine which OCDD waiver will be offered to the individual
				  during the initial plan of care process.
1.
				  The beneficiary or his/her representative may request a reconsideration and
				  present supporting documentation if he/she disagrees with the specific OCDD
				  waiver offered as a result of the needs based assessment and person-centered
				  planning process. If the beneficiary disagrees with the reconsideration
				  decision, he/she may request a fair hearing through the formal appeals
				  process.