reglab/statecodes huggingface dataset:
Louisiana Administrative Code › Title 48 - PUBLIC HEALTH-GENERAL › Part V - Preventive Health Services › Subpart 9 - Home Health Services › Chapter 29 - Services › Section V-2901 - Types of Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. Services
				  Other than Nursing Services. Medical social worker and nutritional counseling
				  services will be provided to clients when ordered by the attending
				  physician.
B. Medical Supplies.
				  Routine medical supplies used by OPPHS staff in the treatment of clients will
				  be provided free of charge.
C.
				  Durable Medical Equipment. Items of equipment such as hospital beds,
				  wheelchairs, walkers, commode chairs, and other equipment which can withstand
				  repeated use and is primarily and customarily used in the home to serve a
				  medical purpose, are not provided to clients.
D. Transportation for Medical Care.
				  Transportation for medical care is not provided to clients.
AUTHORITY NOTE:
					 Promulgated in accordance with R.S. 40:2009.3140:2009.41, Titles XVIII and XIX
					 of the Social Security Act as amended by P.L. 90 :248, 92-603, 93-233, 96-499
					 and 97-248.
Louisiana Administrative Code › Title 48 - PUBLIC HEALTH-GENERAL › Part V - Preventive Health Services › Subpart 9 - Home Health Services › Chapter 29 - Services › Section V-2903 - Providers of Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. All services
				  will be provided free of charge to clients by nursing and ancillary staff of
				  the local parish health units, and the regional offices of the Office of
				  Preventive and Public Health Services.
AUTHORITY NOTE:
					 Promulgated in accordance with R.S. 40:2009.3140:2009.41, Title XVIII and XIX
					 of the Social Security Act as amended by P.L. 90 :248, 92-603, 93-233, 96-499,
					 and 97-248.
Louisiana Administrative Code › Title 48 - PUBLIC HEALTH-GENERAL › Part V - Preventive Health Services › Subpart 9 - Home Health Services › Chapter 29 - Services › Section V-2905 - Service Delivery

Current through Register Vol. 50, No. 6, June 20, 2024
A. Service
				  Area. Statewide, except for Orleans and Plaquemines parishes.
B. Places of Service. All services will be
				  provided in the client's home or place of residence (other than a nursing
				  home).
AUTHORITY NOTE:
					 Promulgated in accordance with R.S.
					 40:2009.3140:2009.41.
Louisiana Administrative Code › Title 48 - PUBLIC HEALTH-GENERAL › Part V - Preventive Health Services › Subpart 9 - Home Health Services › Chapter 29 - Services › Section V-2907 - Request for Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. Clients or
				  members of client's family, client's physician, or any health care facility,
				  may request home care services by contacting the local parish health unit in
				  their area.
AUTHORITY NOTE:
					 Promulgated in accordance with R.S.
					 40:2009.3140:2009.41.
Louisiana Administrative Code › Title 48 - PUBLIC HEALTH-GENERAL › Part V - Preventive Health Services › Subpart 11 - High Blood Pressure Control Services › Chapter 31 - General Provisions › Section V-3101 - Authority

Current through Register Vol. 50, No. 6, June 20, 2024
A. In 1984, the
				  legislature passed Act 701 enacting R. S. 40:2481-2483 to provide a statewide
				  High Blood Pressure Control Program (LHBPCP), under the auspices of the Office
				  of Preventive and Public Health Services.
AUTHORITY NOTE:
					 Promulgated in accordance with R.S.
					 40:2481-2483.
Louisiana Administrative Code › Title 48 - PUBLIC HEALTH-GENERAL › Part V - Preventive Health Services › Subpart 11 - High Blood Pressure Control Services › Chapter 31 - General Provisions › Section V-3103 - Goals and Services

Current through Register Vol. 50, No. 6, June 20, 2024
A.
1. The goal of the LHBPCP is to reduce
				  morbidity and mortality associated with hypertension and its complications
				  (heart disease and stroke) through a comprehensive preventive system. Services
				  are targeted to the high risk population 14 years of age and older. The program
				  provides services in six areas:
a. client
				  education;
b.
				  screening/rescreening;
c.
				  counseling;
d. follow-up;
e. monitoring; and
f. direct referral to physician and hospital
				  for diagnosis and treatment.
Louisiana Administrative Code › Title 48 - PUBLIC HEALTH-GENERAL › Part V - Preventive Health Services › Subpart 13 - Family Planning › Chapter 35 - General Administration › Section V-3501 - Eligibility Requirements

Current through Register Vol. 50, No. 6, June 20, 2024
A. Any
				  person needing and requesting the services provided by the program is eligible.
				  These include women capable of childbearing and those persons seeking
				  infertility services. The male population is eligible for available family
				  planning services.
All persons are eligible to the extent of the program's
					 financial support. Priority shall be given to members of low income
					 families.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 42 USC
					 300, 42 CFR, Subpart A, Part
					 59.
Louisiana Administrative Code › Title 48 - PUBLIC HEALTH-GENERAL › Part V - Preventive Health Services › Subpart 13 - Family Planning › Chapter 37 - Fees › Section V-3701 - Fee Policy

Current through Register Vol. 50, No. 6, June 20, 2024
A. All persons
				  seen for family planning services at an Office of Preventive and Public Health
				  Services health unit or at a site providing family planning services by
				  contract with Office of Preventive and Public Health Services shall be assessed
				  a fee for each chargeable service. Chargeable services are those defined as
				  chargeable under The Louisiana Medicaid Program regardless of the source of
				  payment. Fees will be based on cost and adjusted according to the ability of
				  the recipient to pay.
B. All
				  patients whose gross family income is above 100 percent poverty as determined
				  by the U.S. Community Services Administration as indicated on the fee
				  adjustment schedule shall pay a fee for each service provided. Fees and
				  adjustment to fees are to be established by the fee clerk at the time the
				  patient is registered for service.
C. Patients shall be charged a fee for each
				  service, regardless of which service is provided, in the same manner in which
				  Medicaid is charged. No fee shall be charged for failed or cancelled
				  appointments.
D. Minors seen
				  without the consent and knowledge of parents or legal guardians will be
				  considered as separate family units and will be charged according to the
				  minor's own income whether the source is allowance or earnings.
E. All patients shall be asked to pay their
				  fees at the time of service delivery. However, when patients do not pay at the
				  time of the visit, they shall be handed a "1st Notice of Payment Due". At the
				  end of 60 days, a "2nd Notice of Payment Due" shall be sent out.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 42 USC
					 300; 42 CFR Subpart A, Part
					 59.
Louisiana Administrative Code › Title 48 - PUBLIC HEALTH-GENERAL › Part V - Preventive Health Services › Subpart 13 - Family Planning › Chapter 37 - Fees › Section V-3703 - Fee Adjustment Schedule

Current through Register Vol. 50, No. 6, June 20, 2024
A.
1. The fee adjustment schedule is designed to
				  provide for proportional payment of each service based on the family's ability
				  to pay. Three variable figures are utilized in calculating the schedule:
a. United State Community Services
				  Administration Poverty Guidelines as found in  45 CFR 1060.2 ;
b. family size; and
c. cost of service provided.
Louisiana Administrative Code › Title 48 - PUBLIC HEALTH-GENERAL › Part V - Preventive Health Services › Subpart 13 - Family Planning › Chapter 37 - Fees › Section V-3705 - Changes in Fees

Current through Register Vol. 50, No. 6, June 20, 2024
A. The patient
				  shall be informed that the fee clerk shall be notified of any change which may
				  later occur in income, employment, or family composition which might result in
				  a change in the adjustment fee, and the patient shall so notify the fee clerk.
				  The fee clerk shall also conduct a periodic check (no less frequently than
				  semi-annually) with each patient to determine any change in factors including
				  cost changes, which would cause a change in the fee or adjusted fee. The fee
				  clerk shall adjust the fee appropriately in accordance with the fee adjustment
				  schedule.
B. No fee may be waived
				  or reduced beyond the fee adjustment scale without the express approval of the
				  facility administrator who shall document the reason for change in the
				  patient's chart. When waiver or reduction is made, the administrator shall sign
				  and date such authorization in the case record and in addition shall note and
				  initial the adjusted fee on the ledger card.
C. Examples of acceptable justifications for
				  waiving or reducing a fee include:
1.
				  excessive expense due to other medical cost;
2. family hardships resulting in unusual and
				  unexpected expenses.
Louisiana Administrative Code › Title 48 - PUBLIC HEALTH-GENERAL › Part V - Preventive Health Services › Subpart 13 - Family Planning › Chapter 37 - Fees › Section V-3707 - Failure to Pay Fees

Current through Register Vol. 50, No. 6, June 20, 2024
A. No person shall
				  be denied service because of inability to pay as determined by the foregoing
				  criteria.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 42 USC
					 300, 42 CFR Subpart A, Part
					 59.
Louisiana Administrative Code › Title 48 - PUBLIC HEALTH-GENERAL › Part V - Preventive Health Services › Subpart 13 - Family Planning › Chapter 37 - Fees › Section V-3709 - Failure to Provide Information

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Any person who is potentially eligible for medical assistance benefits from any
				  federal or state program who refuses to apply for and follow through with
				  application for said benefits shall be presumed to be able to pay the maximum
				  cost of services rendered and shall be billed accordingly.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 42 USC
					 300, 42 CFR Subpart A, Part
					 59.
Louisiana Administrative Code › Title 48 - PUBLIC HEALTH-GENERAL › Part V - Preventive Health Services › Subpart 13 - Family Planning › Chapter 37 - Fees › Section V-3711 - Insurance

Current through Register Vol. 50, No. 6, June 20, 2024
A. An insurance
				  company that the responsible party alleges has issued a policy or contract
				  covering the charges for treatment and services rendered shall be billed the
				  full cost of services rendered. Billings shall be made directly to the insurer
				  by the heath unit after securing execution of the forms necessary, including an
				  assignment of benefits to the health unit by the responsible person. The
				  responsible party shall be billed in accordance with the applicable fee
				  schedule up to the amount of charges not covered and paid by insurance. If the
				  responsible person refuses to execute the forms necessary to assign the
				  benefits under the policy alleged by her to cover the charges for services
				  rendered and the forms necessary to file an insurance claim in accordance with
				  the policy, that responsible party shall be billed according to the charges
				  outlined in the class assigned her based on her income and family size as
				  provided in Table I.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 42 USC
					 300, 42 CFR Subpart A, Part
					 59.
Louisiana Administrative Code › Title 48 - PUBLIC HEALTH-GENERAL › Part V - Preventive Health Services › Subpart 13 - Family Planning › Chapter 37 - Fees › Section V-3713 - Collection Procedure

Current through Register Vol. 50, No. 6, June 20, 2024
A. At the end
				  of the clinic visit, outstanding receivable accounts shall be handed a "1st
				  Notice of Payment Due". At the end of 60 days, a "2nd Notice of Payment Due"
				  shall be sent out.
B. No services
				  other than contraceptive method related emergency services shall be provided a
				  client who has not paid on an outstanding account between clinic visit unless
				  the client pays on the account prior to receiving services on the day that
				  services are sought.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 42 USC
					 300, 42 CFR Subpart A, Part
					 59.
Louisiana Administrative Code › Title 48 - PUBLIC HEALTH-GENERAL › Part V - Preventive Health Services › Subpart 15 - Special Supplemental Nutrition Program for Women, Infants and Children (WIC) › Chapter 41 - General Provisions › Section V-4101 - Purpose and Scope

Current through Register Vol. 50, No. 6, June 20, 2024
A. Overview of
				  Program Purpose
1. The Subsidized
				  Guardianship Program enables the Department of Children and Family Services
				  (DCFS) to make payments to certified relative and fictive kin caregivers as
				  well as certified caregivers with a significant familial bond with the child on
				  behalf of a child who otherwise might not be able to achieve permanency outside
				  of department custody because of special needs or other circumstances. Subsidy
				  payments shall be limited to child(ren) for whom guardianship is indicated due
				  to other more permanent options such as reunification with the parents,
				  immediate unsubsidized custody to a relative or other caregiver, or adoption
				  being determined unfeasible for the child. The guardianship subsidy applies
				  only to a child(ren) for whom the DCFS holds legal custody, only to potential
				  caregivers with whom the child has a significant familial bond; with whom it
				  would be in the childs best interest to remain until the age of majority, and
				  when the kinship placement provider or other caregiver with a significant
				  familial bond becomes a certified foster caregiver according to the
				  certification standards of the state, and, the child(ren) remains in the
				  certified kinship placement or placement with the other caregiver with a
				  significant familial bond for at least six consecutive months during the
				  current foster care episode prior to entering the guardianship subsidy
				  arrangement. The guardianship subsidy also applies to successor guardian(s) who
				  meet the following criteria:
a. the successor
				  guardian is named in the guardianship subsidy agreement with DCFS;
b. the successor guardian and all adult
				  household members have satisfactorily completed national fingerprint based
				  criminal and child abuse/neglect background clearances; and
c. guardianship is transferred by a court to
				  the successor guardian in accordance with
Louisiana Childrens
				  Code
articles 718 through 724.1.
Louisiana Administrative Code › Title 48 - PUBLIC HEALTH-GENERAL › Part V - Preventive Health Services › Subpart 15 - Special Supplemental Nutrition Program for Women, Infants and Children (WIC) › Chapter 43 - Participant Eligibility › Section V-4301 - Integration with Health Services

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Whenever possible, (LA WIC) intake procedures shall be combined with intake
				  procedures from other health programs and/or services administered by state and
				  local agencies. Such merging may include verification procedures, certification
				  interviews, and income computations.
1. A list
				  of local counseling and treatment resources for drug and other harmful
				  substance abuse shall be made available to all pregnant, postpartum, and
				  breastfeeding women, and to parents and caretakers of infants and children, any
				  of whom are applying for and participating in LA WIC.
Louisiana Administrative Code › Title 48 - PUBLIC HEALTH-GENERAL › Part V - Preventive Health Services › Subpart 15 - Special Supplemental Nutrition Program for Women, Infants and Children (WIC) › Chapter 43 - Participant Eligibility › Section V-4303 - Eligibility Criteria

Current through Register Vol. 50, No. 6, June 20, 2024
A. To be
				  certified as eligible for LA WIC, applicants shall:
1. reside within the jurisdiction of the
				  state, however, length of residency is not an eligibility
				  requirement;
2. meet the income
				  requirement as described in Subsection B of this Section; and
3. meet nutritional risk criteria as
				  described in Subparagraph d (Priority IV) of Paragraph 4 of Subsection C of
				  this Section and in the state plan.
Louisiana Administrative Code › Title 48 - PUBLIC HEALTH-GENERAL › Part V - Preventive Health Services › Subpart 15 - Special Supplemental Nutrition Program for Women, Infants and Children (WIC) › Chapter 43 - Participant Eligibility › Section V-4305 - Timeframes for Processing Applicants

Current through Register Vol. 50, No. 6, June 20, 2024
A. When LA WIC is not serving its maximum
				  caseload, LA WIC may accept applications, and make eligibility determinations.
				  Applicants shall be notified of the decisions made, and if enrolled, will be
				  issued WIC benefits. These actions shall be accomplished within the timeframes
				  set forth below.
1. The processing timeframes
				  shall begin when an individual visits the WIC clinic during clinic office hours
				  to make an oral or written request for WIC benefits.
2. Special nutritional risk applicants shall
				  be notified of their eligibility or ineligibility within 10 days of the date of
				  the first request for WIC benefits. LA WIC may provide an extension of the
				  notification period to a maximum of 15 days for the WIC clinics which make
				  written request, including a justification of the need for an extension. LA WIC
				  shall establish criteria for identifying categories of persons at special
				  nutritional risk who require expedited services. At a minimum, however, these
				  categories shall include pregnant women eligible as Priority I WIC
				  participants, and migrant farm workers and their family members who soon plan
				  to leave the jurisdiction of the local agency.
3. All other applicants shall be notified of
				  their eligibility or ineligibility within 20 days of the first date of the
				  request for WIC benefits.
4. The
				  WIC clinic or local agency using a retail purchase system shall issue WIC
				  benefits benefits to the WIC Participant at the same time as notification of
				  certification. The WIC benefits benefits issued should be valid for the current
				  month and shall be redeemable immediately upon receipt by the WIC
				  Participant.
Louisiana Administrative Code › Title 48 - PUBLIC HEALTH-GENERAL › Part V - Preventive Health Services › Subpart 15 - Special Supplemental Nutrition Program for Women, Infants and Children (WIC) › Chapter 43 - Participant Eligibility › Section V-4307 - Certification Periods

Current through Register Vol. 50, No. 6, June 20, 2024
A. WIC benefits
				  shall be based upon certifications established in accordance with the following
				  timeframes.
1. Pregnant women shall be
				  certified for the duration of their pregnancy and for up to six weeks
				  postpartum.
2. Postpartum women
				  shall be certified for up to six months postpartum.
3. Breastfeeding women shall be certified at
				  intervals of approximately six months and ending with the breastfed infant's
				  first birthday.
4. Infants shall be
				  certified up until their first birthday.
5. Children shall be certified at intervals
				  of approximately one year and ending with the end of the month in which a child
				  reaches its fifth birthday. WIC clinic staff shall ensure children certified
				  for a year shall be offered a mid-certification assessment, which includes a
				  health and nutrition assessment (review of anthropometrics, blood work, and a
				  brief update of the health and dietary assessment), immunizations screening,
				  nutrition education, and referrals to other health and social services, within
				  a certification period. Food benefits shall not be denied to parents/guardians
				  who refuse to obtain the mid-certification assessment for their
				  children.
Louisiana Administrative Code › Title 48 - PUBLIC HEALTH-GENERAL › Part V - Preventive Health Services › Subpart 15 - Special Supplemental Nutrition Program for Women, Infants and Children (WIC) › Chapter 43 - Participant Eligibility › Section V-4309 - WIC Participant Rights and Responsibilities/Notification/Fair Hearing

Current through Register Vol. 50, No. 6, June 20, 2024
A. WIC Participant
				  Rights and Responsibilities. All applicants shall read or have read to them the
				  programs' rights and responsibilities statement, including the restriction of
				  dual participation in the program. After reviewing the statement, all
				  applicants shall sign attesting to have reviewed the statement.
B. Notification of Ineligibility. WIC
				  participants found ineligible during a certification period shall be advised in
				  writing of the ineligibility, the reasons for the ineligibility and of the
				  right to a fair hearing.
C.
				  Notification of Disqualification. WIC participants who are about to be
				  disqualified from program participation during a certification period shall be
				  advised in writing not less than 15 days before the effective date of
				  disqualification, of the reasons for the disqualification and the right to a
				  fair hearing.
D. Fair Hearing
				  Procedures for WIC participants. LA WIC provides a hearing procedure through
				  which any individual may appeal, within sixty days of the date of notification
				  by LA WIC, an action which results in the denial of participation or the
				  disqualification from LA WIC.
1. The hearing
				  process is governed by the procedures set forth in the Administrative Procedure
				  Act, R.S.
				  49:950 et seq., and as mandated by WIC
				  federal regulations,  7 CFR part 246.
2. LA WIC shall not summarily deny or dismiss
				  an appeal unless:
a. the request is withdrawn
				  in writing by the appellant or legal representative of the appellant;
b. the appellant or legal representative
				  fails, without good cause, to appear at the scheduled hearing; or
c. the appellant has been denied
				  participation by a previous decision following a hearing and does not allege in
				  the request for appeal that circumstances relevant to program eligibility have
				  changed in such a way as to justify a new hearing.
3. LA WIC shall continue WIC benefits for a
				  WIC participant whose participation has been terminated during a certification
				  period if a request for an appeal is received within the 15 days of advance
				  notification of disqualification. WIC benefits shall continue until the hearing
				  officer reaches a decision or the certification period expires, whichever
				  occurs first. Applicants who are denied WIC benefits at initial certification
				  or because of the expiration of their certification may appeal the denial, but
				  shall not receive WIC benefits while pending the hearing and decision of the
				  hearing officer.
4. A WIC
				  participant or representative may appeal the fair hearing decision through
				  judicial review as provided for in the Louisiana Administrative Procedure
				  Act.
Louisiana Administrative Code › Title 48 - PUBLIC HEALTH-GENERAL › Part V - Preventive Health Services › Subpart 15 - Special Supplemental Nutrition Program for Women, Infants and Children (WIC) › Chapter 45 - Vendor Selection, Participation and Sanctions › Section V-4501 - Reserved

Current through Register Vol. 50, No. 6, June 20, 2024
AUTHORITY NOTE:
					 Promulgated in accordance with  7 CFR Part 246, and
					 42
					 USC 1786.
Louisiana Administrative Code › Title 48 - PUBLIC HEALTH-GENERAL › Part V - Preventive Health Services › Subpart 15 - Special Supplemental Nutrition Program for Women, Infants and Children (WIC) › Chapter 45 - Vendor Selection, Participation and Sanctions › Section V-4507 - WIC Transaction Processing and Reimbursement and Claims by LA WIC

Current through Register Vol. 50, No. 6, June 20, 2024
A. Only authorized
				  WIC vendors may transact WIC benefits.
B. LA WIC will establish a vendor peer group
				  system, place vendors into peer groups, and set allowable reimbursement levels
				  for each peer group for the purpose of cost containment. If an above-50-percent
				  (A-50) vendor is needed for participant access, LA WIC will place the A-50
				  vendor into a peer group for vendors designated as A-50.
C. A vendor shall process WIC transactions as
				  outlined in the vendor guide and policy manual. LA WIC shall reimburse a vendor
				  in accordance with its peer group, making adjustments as required by WIC
				  federal regulations.
D. A vendor
				  shall maintain and operate its WIC EBT system in compliance with the USDA/FNS's
				  WIC operating rules for EBT, the technical implementation guide, the vendor
				  rules and regulations and any changes thereto.
E. If a vendor submitted a claim for
				  reimbursement that was rejected or the payment amount for the claim for
				  reimbursement was adjusted by the LA WIC-contracted EBT processor or bank with
				  which the vendor disagrees, the vendor may submit its dispute of the rejection
				  of (or adjustment to) the reimbursement according to the process outlined in
				  the vendor guide and policy manual. Any dispute submitted untimely shall be
				  denied. Disputes that exceed the federal monetary threshold are subject to USDA
				  approval. Vendors shall be notified of adverse reimbursement
				  decisions.
F. LA WIC shall
				  establish a claim against the vendor for any amounts owed to the program (e.g.,
				  overcharges, unauthorized items, excess WIC approved food items, excess
				  payments, deficiencies identified during an inventory audit, and adjustment to
				  the vendor's claim for reimbursement). Disqualification and/or termination of
				  the vendor agreement or payment of a civil money penalty (CMP) does not relieve
				  the vendor of the obligation to repay any monies claimed by and owed to LA WIC.
				  LA WIC may refer debts to the Louisiana Department of Revenue, Office of Debt
				  Recovery and/or commence action in the 19th Judicial District Court to recover
				  the outstanding claim amount and/or pursue any other remedies allowed to LA WIC
				  by law.
AUTHORITY
					 NOTE: Promulgated in accordance with
					 R.S.
					 46:972 and
					 R.S.
					 47:1676.
Louisiana Administrative Code › Title 48 - PUBLIC HEALTH-GENERAL › Part V - Preventive Health Services › Subpart 15 - Special Supplemental Nutrition Program for Women, Infants and Children (WIC) › Chapter 45 - Vendor Selection, Participation and Sanctions › Section V-4509 - Vendor Sanctions for Violations

Current through Register Vol. 50, No. 6, June 20, 2024
A. Pattern of Incidences.
1. WIC federal regulations at
				  7 CFR §
												246.12(I)(2)(i) mandate that
				  state agency sanction(s) must be based on a pattern of violative
				  incidences.
2. Federal guidance
				  from the USDA WIC Vendor Management and Food Delivery Handbook (Sept. 2017,
				  section
				  9.1.2, pg. 35)
				  mandates that LA WIC must develop a definition of a pattern of violations. Some
				  federal mandatory vendor sanctions and all state agency vendor sanctions must
				  be based on a pattern of violations [See
				  7 CFR §
												246.12(l)(1) and
				  7 CFR
				  §246
				  12(l)(2)(i)]. The definition of a pattern of violations may be different for
				  different types of violations (e.g., to account for severity). The definition
				  of a pattern of violations is stated in the vendor rules and
				  regulations.
3. WIC federal
				  regulations at 7 CFR §
												246.12(h)(3)(xix) mandate
				  that LA WIC must notify a vendor in writing when an investigation reveals an
				  initial incidence of a violation for which a pattern of incidences must be
				  established in order to impose a sanction, before another such incidence is
				  documented, unless LA WIC determines, in its discretion, on a case-by-case
				  basis, that notifying the vendor would compromise an investigation.
				  Notification shall not be provided for a pattern of claiming reimbursement for
				  the sale of an amount of a WIC approved food item at the category level that
				  exceeds documented inventory. See
				  7 CFR §
												246.12(l)(3).
4. Unaddressed violations will carry from one
				  agreement period to the next.
Louisiana Administrative Code › Title 48 - PUBLIC HEALTH-GENERAL › Part V - Preventive Health Services › Subpart 15 - Special Supplemental Nutrition Program for Women, Infants and Children (WIC) › Chapter 45 - Vendor Selection, Participation and Sanctions › Section V-4511 - Administrative Review of Adverse Actions

Current through Register Vol. 50, No. 6, June 20, 2024
A. Some adverse actions taken by LA WIC that
				  affect vendors or vendor applicants may be subject to administrative review, if
				  appealed.
B. LA WIC shall provide
				  written notification of the adverse action, the procedures to follow to request
				  an administrative review (full or abbreviated), if applicable, and the cause(s)
				  for and the effective date of the action. If the vendor is disqualified due in
				  whole or in part to federal mandatory vendor sanction violations of
				  §4509 of this
				  Subpart, such notification shall include the following statement: "This
				  disqualification from WIC may result in disqualification as a retailer in SNAP.
				  Such disqualification is not subject to administrative or judicial review under
				  SNAP."
C. If the vendor or vendor
				  applicant wishes to appeal the decision, and the adverse action is appealable,
				  the vendor or vendor applicant shall submit a request for appeal stating the
				  permissible reason(s) for appeal. The request shall be submitted to LA WIC
				  within 15 days after the date of the notice of the adverse action.
D. Effective Date of Adverse Actions Against
				  Vendors. Denials of WIC authorization and permanent disqualifications imposed
				  under §4509 of this
				  Subpart are effective on the date of receipt of the notice of adverse action.
				  All other adverse actions are effective 15 days after the date of the notice of
				  the adverse action.
E. Adverse
				  Actions Subject to Full Administrative Review:
1. The following adverse actions are subject
				  to full administrative review.
a. denial of
				  WIC authorization based on the application of the vendor selection criteria of
				  failure to stock and maintain sufficient quantities and varieties of all WIC
				  approved food items in accordance with LA WIC's minimum stock
				  requirements;
b. denial of WIC
				  authorization based on a determination that the vendor is attempting to
				  circumvent a sanction;
c.
				  termination of an agreement for cause, which does not include termination of an
				  agreement because of a change in ownership or location, or cessation of
				  operations, or expiration of an agreement;
d. disqualification,; or
e. imposition of a fine or a civil money
				  penalty (CMP) in lieu of disqualification.
Louisiana Administrative Code › Title 48 - PUBLIC HEALTH-GENERAL › Part V - Preventive Health Services › Subpart 15 - Special Supplemental Nutrition Program for Women, Infants and Children (WIC) › Chapter 45 - Vendor Selection, Participation and Sanctions › Section V-4513 - Availability of Documents

Current through Register Vol. 50, No. 6, June 20, 2024
A. The vendor
				  application, the vendor agreement, and the WIC vendor guide shall be provided
				  for review to any interested party by submission of an e-mail request to
				  LAWICVendor@la.gov.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 46:972.
Louisiana Administrative Code › Title 48 - PUBLIC HEALTH-GENERAL › Part V - Preventive Health Services › Subpart 17 - Children's Special Health Services (CSHS) › Chapter 49 - General Provisions › Section V-4901 - Purpose and Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. Purpose.
				  Children's Special Health Services (CSHS) provides for the care of children in
				  Louisiana with certain special health care needs ( birth to 21
				  years).
B. Services Provided
1. Service Level I. CSHS provides general
				  services for all children in Louisiana with special health care needs. Services
				  are directed through information gathering, setting of service standards,
				  program planning, public education, referral and family empowerment.
2. Service Level II. The program offers child
				  specific medical care coordination for those families needing this service as
				  determined by CSHS regional staff.
3. Service Level III. The Program offers
				  child specific wraparound services which may include assessment,
intervention, and follow-up nursing, social and nutrition
					 services. Other support services may include care coordination,
					 parent-to-parent support, transition planning, and other allied health
					 services.
4. Service Level
				  IV. For those families who are financially and medically eligible (as defined
				  in Chapter 51), the Program offers direct medical diagnostic and treatment
				  services in addition to the services provided in Levels I, II and III. These
				  direct medical services are available for children with certain chronic
				  physical illnesses or serious disabilities which can be treated through an
				  outpatient clinic approach.
a. These direct
				  medical diagnostic and treatment services may include the provision of /or
				  payment for hospitalizations, medications, (re)habilitative appliances and
				  devices, medical equipment and allied health services as ordered by physicians
				  on contract to CSHS.
b. Families
				  receiving services from the Program are required to contribute financially
				  through any form of medical insurance, (i.e., private, managed care plans,
				  Medicaid or Medicare). Families may be required to make direct payment for
				  services to vendors. A determination of ability to financially contribute is
				  made by designated CSHS regional staff.
Louisiana Administrative Code › Title 48 - PUBLIC HEALTH-GENERAL › Part V - Preventive Health Services › Subpart 17 - Children's Special Health Services (CSHS) › Chapter 49 - General Provisions › Section V-4903 - Referrals

Current through Register Vol. 50, No. 6, June 20, 2024
A. Referrals to the
				  Program
1. Families may be referred to the
				  program by physicians, public health nurses, audiologists, private and public
				  hospitals, other health care agencies and other Office of Public Health (OPH)
				  Programs.
2. The usual point of
				  entry into the program is through the OPH health unit in the child's parish of
				  residence.
3. The public health
				  nurse at the OPH health unit shall obtain needed information to complete the
				  CSHS Application, provide the family an explanation about the program and send
				  the application to the appropriate CSHS Regional Office for review and
				  disposition.
4. Emergency medical
				  referrals may be made directly to the CSHS Regional Office by telephone contact
				  from physicians, nurses and hospital social workers. Examples of such referrals
				  are a new-born infant with spina bifida, a child with a heart condition or
				  hydrocephalus needing immediate medical attention or surgery.
Louisiana Administrative Code › Title 48 - PUBLIC HEALTH-GENERAL › Part V - Preventive Health Services › Subpart 17 - Children's Special Health Services (CSHS) › Chapter 49 - General Provisions › Section V-4905 - Definitions

Current through Register Vol. 50, No. 6, June 20, 2024
A. For the purpose
				  of this Subpart the following definitions shall apply:
1. Child-a child is an individual from birth
				  until twenty-first (21st) birthday.
2. Applicant-an applicant is the child for
				  whom services are requested.
3.
				  Family-a family is a group of people related by blood, marriage and/or legal
				  adoption living together as one economic unit and supported by the reported
				  income.
Louisiana Administrative Code › Title 48 - PUBLIC HEALTH-GENERAL › Part V - Preventive Health Services › Subpart 17 - Children's Special Health Services (CSHS) › Chapter 51 - Eligibility for Service Level IV › Section V-5103 - Appeal Process for Denied Applications

Current through Register Vol. 50, No. 6, June 20, 2024
A. The Eligibility Determination Value shall
				  be calculated at the time of initial application to the Program and annually
				  thereafter, or, when a major expenditure is anticipated, or, whenever staff
				  becomes aware of major changes in any portion of the formula. These changes may
				  include salary raises, unemployment, additions or deletions of family members
				  from the home, or any changes in the medical category. If such a
				  redetermination of eligibility occurs prior to a major expenditure (i.e.
				  hospitalization, purchase of an appliance or home IV therapy lasting longer
				  than 10 days, etc.) and the family is determined to be no longer eligible for
				  services, the expenditure may be covered prior to discharge from the
				  Program.
B. The CSHS Regional Staff
				  shall document extenuating circumstances that may arise and refer them to the
				  CSHS Program Manager for special consideration. The CSHS Program Manager may
				  convene the Administrative Unit made up of CSHS Program Specialist, medical,
				  nursing, social service, nutrition and parent consultants for a team decision
				  which then becomes the Program Manager's final decision.
C. When an application is denied, for
				  whatever reason, the denial must be written, dated and hand delivered or sent
				  by certified mail to the applicant's parents or legal representative. The
				  letter of denial shall include information on the family's right to have the
				  denial referred for an Administrative Review. The family must request an
				  Administrative Review in writing within 15 days of the date of certified
				  mailing or hand-delivery of the notice of denial. The written request will be
				  forwarded by CSHS Regional Staff to the CSHS Program Manager for
				  reconsideration.
D. After the
				  Administrative Review, the CSHS Program Manager's decision shall be forwarded
				  to the applicant's parents/or legal representative through the CSHS Regional
				  Office. If the applicant's parent/legal representative disagrees with the
				  decision, a fair hearing may be requested within 30 days from the date of
				  mailing or hand-delivery of the Administrative Review denial.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S. 40:31.2,
					 R.S.
					 40:1299. 111-120, and Title XIX, Public
					 Health Service Act, §1905
Louisiana Administrative Code › Title 48 - PUBLIC HEALTH-GENERAL › Part V - Preventive Health Services › Subpart 17 - Children's Special Health Services (CSHS) › Chapter 51 - Eligibility for Service Level IV › Section V-5105 - Redetermination

Current through Register Vol. 50, No. 6, June 20, 2024
A. Eligibility
				  redetermination shall be calculated annually or when a major expenditure is
				  anticipated or whenever staff becomes aware of major changes in any portion of
				  the formula. These changes may include salary raises, unemployment, additions
				  or deletions of family members from the home, or any changes in the medical
				  category. If such a redetermination of eligibility occurs prior to a major
				  expenditure (i.e., hospitalization, purchase of an appliance or home IV therapy
				  lasting longer than 10 days, etc.) and the family is determined to be no longer
				  eligible for services, the expenditure may be covered prior to discharge from
				  the Program.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S. 40:31.2,
					 40:1299.111-120;
					 Title XIX, Public Health Service Act, Section 1905
Louisiana Administrative Code › Title 48 - PUBLIC HEALTH-GENERAL › Part V - Preventive Health Services › Subpart 17 - Children's Special Health Services (CSHS) › Chapter 51 - Eligibility for Service Level IV › Section V-5107 - Notification of Eligibility Status

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  All families will be notified in writing of their eligibility status as soon as
				  all documentation (financial and medical) has been received, reviewed and
				  determination of eligibility has been made by the CSHS Regional
				  Staff.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S. 40:31.2,
					 40:1299.111-120;
					 Title XIX, Public Health Service Act, Section 1905
Louisiana Administrative Code › Title 48 - PUBLIC HEALTH-GENERAL › Part V - Preventive Health Services › Subpart 17 - Children's Special Health Services (CSHS) › Chapter 51 - Eligibility for Service Level IV › Section V-5109 - Ineligibility

Current through Register Vol. 50, No. 6, June 20, 2024
A. When an
				  application is determined ineligible for CSHS Service Level IV, the CSHS
				  Regional Staff may:
1. assist in finding and
				  contacting another resource;
2.
				  provide verbal and/or written referral to another care provider (public or
				  private);
3. provide supportive
				  services until the child is known to be receiving needed care; and
4. provide supportive and/or referral
				  services for other family members, if needed.
Louisiana Administrative Code › Title 48 - PUBLIC HEALTH-GENERAL › Part V - Preventive Health Services › Subpart 17 - Children's Special Health Services (CSHS) › Chapter 51 - Eligibility for Service Level IV › Section V-5113 - Medical Diagnosis, Care and Treatment Consent

Current through Register Vol. 50, No. 6, June 20, 2024
A. Consent for Medical Diagnosis, Care and
				  Treatment form must be signed by the patient, parent(s), or guardian(s) prior
				  to the provision of any diagnostic or treatment services by CSHS.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S. 40:31.2,
					 R.S.
					 40:1299.111-120, and Title XIX, Public Health
					 Service Act, Section 1905
Louisiana Administrative Code › Title 48 - PUBLIC HEALTH-GENERAL › Part V - Preventive Health Services › Subpart 17 - Children's Special Health Services (CSHS) › Chapter 51 - Eligibility for Service Level IV › Section V-5115 - Case Closure

Current through Register Vol. 50, No. 6, June 20, 2024
A. Cases are
				  closed by CSHS only after it has been clearly established that at least one of
				  the following reasons exist. The following are closure codes and corresponding
				  reasons.
Code
Reasons
01
Financial ineligibility/unable to establish
								eligibility
02
Definite diagnosis not established within one (1)
								year
03
Further treatment not indicated
04
Family no longer interested
05
No CSHS treatment available
06
No treatment indicated
07
Over age
08
Under care of another agency
09
Under private care
10
Refusal to sign necessary required documents
								(i.e., subrogation, insurance, etc.) and/or make application to other funding
								sources (i.e., SSI, Medical Needy, Medicaid, etc.)
11
Moved from the State of Louisiana
12
Death
13
Other
The "Other" category is used only after thorough
								assessment and intervention.
Examples of situations falling in the "Other"
								category are: a. Excessive (3) missed appointments b. Non-compliance with
								treatment plan to the extent that the patient's progress is impeded (CSHS
								Central Office disposition is required prior to closure.)
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S. 40:31.2,
					 R.S.
					 40:1299.111-120, and Title XIX, Public Health
					 Service Act, Section 1905
Louisiana Administrative Code › Title 48 - PUBLIC HEALTH-GENERAL › Part V - Preventive Health Services › Subpart 17 - Children's Special Health Services (CSHS) › Chapter 51 - Eligibility for Service Level IV › Section V-5117 - Lawsuits Filed on Behalf of Patients without Medicaid Coverage

Current through Register Vol. 50, No. 6, June 20, 2024
A. When the
				  patient, parent(s) or guardian(s) file a law suit to recover financial
				  compensation for injuries sustained by the patient, the intervention and
				  subrogation agreement form must be signed and notarized. This completed form
				  (Exhibit III) must be returned to the CSHS Regional Office in the region of
				  residence of the patient. Failure to execute and submit the Intervention and
				  Subrogation form within 30 days of the date of mailing or hand-delivery of the
				  form will cause the patient to be discharged from the Program.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S. 40:31.2,
					 R.S.
					 40:1299. 111-120, and Title XIX, Public
					 Health service Act, §1905
Louisiana Administrative Code › Title 48 - PUBLIC HEALTH-GENERAL › Part V - Preventive Health Services › Subpart 17 - Children's Special Health Services (CSHS) › Chapter 55 - Congenital Anomalies and Spinal Cord Dysfunctions › Section V-5501 - Physician Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. Medical
				  Staff Categories
1. Attending Physicians.
				  CSHS attending physicians (also known as staff or contract physicians) are
				  those physicians with whom CSHS has a signed contract for direct medical
				  services. The CSHS attending physician provides the medical component of the
				  multidisciplinary team care provided to CSHS patients. These medical services
				  are primarily provided in CSHS clinics but may also involve provision of care
				  in hospitals, clinics, private offices or other out-patient settings. The
				  attending physician is the CSHS physician of record and is authorized to order
				  medically necessary procedures such as lab, x-ray, rehabilitative therapy,
				  hospitalization, medications, equipment and supplies as well as make referrals
				  and requests for services from other agencies.
a. CSHS attending physicians receive no
				  direct reimbursement from the Program for services to CSHS patients. Instead a
				  limited number of honorariums are granted as they become available. Travel
				  expenses for attending physicians are reimbursed as per Louisiana Division of
				  Administration Policy and Procedure. CSHS attending physicians must also be
				  willing to serve, if requested, on CSHS Regional Office Advisory Boards and/or
				  Quality Assurance Committees.
Louisiana Administrative Code › Title 48 - PUBLIC HEALTH-GENERAL › Part V - Preventive Health Services › Subpart 17 - Children's Special Health Services (CSHS) › Chapter 55 - Congenital Anomalies and Spinal Cord Dysfunctions › Section V-5503 - Hospital Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. CSHS
				  contracts individually with hospitals statewide to provide hospital in-patient
				  care as ordered by the CSHS attending physicians. Hospitalizations are
				  authorized only for facilities with contracts with CSHS.
B. Prior authorization is required before a
				  child may be hospitalized. This authorization is issued from the CSHS Regional
				  Office in the child's region of residence. Authorization is issued for an
				  estimated number of days and is not to exceed 15 days without approval from the
				  CSHS Central Office. Requests for extensions of hospitalization authorization
				  are reviewed for disposition by the CSHS Central Office.
C. In-patient hospital expenses shall be paid
				  by the Program only when services provided are directly related to the
				  condition(s) being treated by CSHS.
D. Children shall be hospitalized only with
				  parental agreement and consent. Admission and consent forms used are those of
				  the designated hospital and shall be signed by the parent (or legal
				  representative) who must appear at that facility.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S. 40:31.2,
					 and
					 R.S.
					 40:1299.111-120.