Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 1 - General Provisions › Chapter 5 - Admissions › Section II-505 - Categorical Advance Group Determinations

Current through Register Vol. 50, No. 6, June 20, 2024
A. In order to assure timely and appropriate
				  care for applicants, the level II authority may make an advance group
				  determination by category that takes into account that certain diagnoses,
				  levels of severity of illness or need for a particular service clearly
				  indicates the need for nursing facility admission or that the provision of
				  specialized services is not normally needed. The applicable level II authority
				  may make an advance group determination that nursing facility care is needed
				  for persons in the following categories.
1.
				  Convalescent Care. If an applicant appears to be in need of level II assessment
				  but is hospitalized for a serious illness and needs time to convalesce before a
				  valid level II assessment can be performed, provisions may be made for
				  temporary medical certification for nursing facility care. The maximum period
				  of time that a level II assessment may be delayed is 100 days. The period of
				  convalescence allowed will be consistent with the diagnosis and medical
				  condition of the individual.
2.
				  Terminal Illness. Terminally ill applicants, who are not a danger to themselves
				  or others, may be categorically approved for nursing facility admission. This
				  categorical eligibility determination is valid for six months at a time, in
				  accordance with the definition of terminal illness used for hospice purposes,
				  and remains valid as long as the applicant's mental condition does not create a
				  barrier to receiving the necessary nursing facility services.
3. Severe Physical Illness. Severely ill
				  applicants, who are not a danger to themselves or others and whose medical
				  condition prevents them from engaging in specialized services, may be
				  categorically approved for nursing facility admission. The attending physician
				  shall determine that the applicant is unable to benefit from specialized
				  services due to the severe level of physical impairment. This categorical
				  determination also remains valid for six months to allow for an individualized
				  assessment of the resident's needs. Severe physical conditions considered in
				  this category include, but are not limited to:
a. coma;
b. ventilator dependence;
c. functioning at a brain stem
				  level;
d. advanced chronic
				  obstructive pulmonary disease;
e.
				  Parkinson's disease;
f.
				  Huntington's disease;
g.
				  amyotrophic lateral sclerosis; and
h. congestive heart failure.
4. Provisional Admissions
a. An applicant who is not a danger to
				  himself or others, but who exhibits symptoms of delirium, may be categorically
				  approved for nursing facility admission pending further assessment when the
				  delirium clears and an accurate diagnosis can be made. This categorical
				  determination may be valid for a period not to exceed 30 days.
b. An applicant who is in an emergency
				  situation and requires protective services may be categorically approved for
				  nursing facility admission pending further assessment. This categorical
				  determination may be valid for a period not to exceed seven days.
5. Respite Care. An applicant who
				  qualifies for nursing facility care and is not a danger to self or others, but
				  resides at home with care from a family member or other caregiver, may be
				  categorically approved for admission in order to provide respite to the in-home
				  caregiver. Respite provides relief to the caregiver when that individual is
				  unable to provide care for a short period of time.
6. Dementia/ID. This category applies to
				  applicants who are intellectually disabled or have indications of intellectual
				  disability, but also exhibit symptoms associated with dementia. These
				  individuals require supervision in a structured environment and a planned
				  program of activities. This categorical determination may remain valid for a
				  period not to exceed one year or until such time that the level II authority
				  makes a determination that an alternative placement is more
				  appropriate.