Louisiana Administrative Code › Title 48 - PUBLIC HEALTH-GENERAL › Part V - Preventive Health Services › Subpart 9 - Home Health Services › Chapter 27 - Eligibility › Section V-2701 - Criteria

Current through Register Vol. 50, No. 6, June 20, 2024
A. Any resident of
				  Louisiana, (exclusive of Orleans and Plaquemines parishes), who is essentially
				  homebound, 21 years of age or older and in need of skilled nursing services
				  ordered by a physician, may receive home care services. Services shall only be
				  provided to clients who do not have third party coverage (i.e., Medicare,
				  Medicaid or private insurance), and who meet financial eligibility guidelines
				  established by the Office of Preventive and Public Health Services.
B. Homebound. Clients shall be considered
				  essentially homebound if they are unable to leave their home, or place of
				  residence, without the aid of supportive devices such as crutches, canes,
				  walkers or wheelchairs, the use of special transportation, the assistance of
				  another person, or if they have a condition which is such that leaving their
				  home is medically contraindicated.
C. 21 Years of Age. Clients must be 21 years
				  of age or older in order to receive home care services.
D. Need of Skilled Nursing Services. Clients
				  must be in need of skilled nursing services in order to receive home care
				  services. These services shall be provided by a registered professional nurse
				  (public health nurse) or a licensed practical nurse under the direct
				  supervision of a registered nurse. All services shall be provided in accordance
				  with the written orders of a physician licensed to practice in the state of
				  Louisiana. Under normal circumstances, clients will be limited to two skilled
				  nursing visits per week. Exceptions to this limit shall only be allowed for
				  medical emergencies, or if the client's physician deems additional visits are
				  medically necessary.
E. Third Party
				  Coverage. Home care services shall only be provided to clients who do not have
				  third party coverage. Such coverage includes Medicare (Part A or Part B),
				  Medicaid, (Title XIX Medical Assistance administered by the Office of Family
				  Security), or private insurance (Blue Cross/Blue Shield or other commercial
				  third party insurance coverage). Clients who are eligible for Medicare coverage
				  (Part A or Part B) who have been denied coverage for home health services by
				  the Medicare fiscal intermediary, shall be considered eligible for home care
				  services. Clients who are eligible for home health services under Medicaid, but
				  who have exhausted their 50 visit limitation, shall be considered eligible for
				  home care services.
F. Financial
				  Eligibility Guidelines. Home care services shall be provided only to clients
				  whose family income does not exceed the following financial eligibility
				  guidelines.
Family Size
Monthly Income
1
2
$1,877
3
$2,212
4
$2,450
5
$2,509
6
$2,571
7
$2,574
AUTHORITY NOTE:
					 Promulgated in accordance with R.S. 40:2009.3140:2009.41, Title XVIII and XIX
					 of the 1965 Admendments to the Social Security Act as amended by P.L. 90 :248,
					 92-603, 93-233, 96-499 and 97-248.