reglab/statecodes huggingface dataset:
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 1 - General Provisions › Chapter 5 - Admissions › Section II-501 - Preadmission Screening

Current through Register Vol. 50, No. 6, June 20, 2024
A. Preadmission
				  screening shall be performed for all individuals seeking admission to a
				  Medicare or Medicaid-certified nursing facility, regardless of the source of
				  payment for the nursing facility services or the individuals known diagnoses.
				  The purpose of the preadmission screening and resident review (PASRR) process
				  is to identify applicants or residents who have a diagnosis of serious mental
				  illness or mental retardation (hereafter referred to as
				  intellectual/developmental disability) and to determine whether these
				  individuals require nursing facility services and/or specialized services for
				  their mental condition.
1. An individual is
				  considered to have a serious mental illness (MI) if the individual meets the
				  requirements on diagnosis, level of impairment and duration of illness as
				  described in federal regulations.
a.
				  Diagnosis. The individual has a diagnosis of major mental disorder as
				  categorized by the Diagnostic and Statistical Manual of Mental Disorders, 4th
				  Edition (DSM IV) or its successor.
i. A
				  mental disorder may include schizophrenia, mood, paranoid, panic, or other
				  severe anxiety disorder, somatoform disorder, personality disorder, other
				  psychotic disorder, or another mental disorder that may lead to a chronic
				  disability.
ii. A primary diagnosis
				  of dementia, including Alzheimer's disease or a related disorder, or a
				  non-primary diagnosis of dementia would not be included as a mental disorder
				  unless the primary diagnosis is a major mental disorder as previously
				  defined.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 1 - General Provisions › Chapter 5 - Admissions › Section II-503 - Medical Certification

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Evaluative data for medical certification (level of care determination) must be
				  submitted to the Office of Aging and Adult Services (OAAS) or its designee for
				  all initial admissions to and requests for continued stays in Medicare or
				  Medicaid-certified nursing facilities, regardless of payer source.
1. Initial Admissions
a. Required Documents. The following
				  documents are required for initial admission to a nursing facility. The initial
				  admission process does not begin until all of the following documents are
				  complete and submitted by OAAS. These documents must not be dated more than 30
				  calendar days prior to the date of admission and must reflect the individuals
				  current functioning:
i. a level of care
				  eligibility tool (LOCET) assessment;
ii. a preadmission screening and resident
				  review (level I PASRR) form completed by a qualified health care professional.
				  The level 1 PASRR form must be signed and dated on the date that it is
				  completed. The level I PASRR form addresses the specific identifiers of MI or
				  I/DD that indicate that a more in-depth evaluation is needed to determine the
				  need for specialized services. The need for this in-depth assessment does not
				  necessarily mean that the individual cannot be admitted to a nursing facility,
				  only that the need for other services must be determined prior to admission;
(a). if the information on the level I PASRR
				  indicates that the individual may have a diagnosis of MI and/or I/DD, and the
				  individual meets the criteria for nursing facility level of care, the
				  individual shall be referred to the Office of Behavioral Health or the Office
				  for Citizens with Developmental Disabilities (the states mental health and
				  intellectual disability level II authorities) for a level II screening to
				  determine if the individual requires the level of services provided by a
				  nursing facility and whether specialized services are needed. Medical
				  certification is not guaranteed for an individual who has been referred for a
				  level II screening. A Medicaid-certified nursing facility shall not admit an
				  individual identified for a level II screening until the screening has been
				  completed and a decision is made by the level II authority;
(b). if there is no indication on the level I
				  PASRR or in other records that the individual may have a diagnosis of MI and/or
				  I/DD and he/she meets the criteria for nursing facility level of care, OAAS may
				  approve the individual for admission to the nursing facility;
iii. for nursing facility
				  admission under a specialized level of care, additional documentation that
				  supports the need for specialized care; and
iv. OAAS or its designee may require the
				  submittal of additional documentation to support the need for a nursing
				  facility stay.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 1 - General Provisions › Chapter 5 - Admissions › Section II-507 - Exempted Hospital Discharges

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  An individual who is being discharged from a hospital and is seeking nursing
				  facility admission may be exempt from preadmission screening if all of the
				  following criteria are met:
1. the individual
				  is being admitted to a nursing facility (NF) directly from a hospital after
				  receiving acute inpatient care;
2.
				  the individual requires NF services for the condition for which he or she
				  received care in the hospital; and
3. his/her attending physician has certified
				  before the admission to the facility that he or she is likely to require less
				  than 30 days of nursing facility services.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 1 - General Provisions › Chapter 5 - Admissions › Section II-509 - Changes in Level of Care and Status

Current through Register Vol. 50, No. 6, June 20, 2024
A. The nursing facility shall notify the
				  parish Medicaid office via the BHSF Form 148 of the following changes in a
				  residents circumstances:
1. change in the
				  level of care;
2. transfer to
				  another nursing facility;
3. change
				  in payer source;
4. hospital/home
				  leave and returns; or
5. discharge
				  home, death or any other breaks in facility care.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 1 - General Provisions › Chapter 5 - Admissions › Section II-511 - Denials and Appeals Process

Current through Register Vol. 50, No. 6, June 20, 2024
A. If an
				  individual is determined not to need nursing facility services and is denied
				  admission, the individual has a right to appeal the decision through the
				  department's established appeal procedures.
1. A denial notice will be sent to the
				  individual and he/she may use that letter to request a fair hearing.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 101 - Standards for Payment for Nursing Facilities › Subchapter B - General Provisions › Section II-10105 - Provider Enrollment

Current through Register Vol. 50, No. 6, June 20, 2024
A. In order
					 to participate as a provider of nursing services under Medicaid, a facility
					 must meet certification requirements and enter into a provider agreement with
					 the Department of Health and Hospitals. A provider agreement is the basis for
					 payments by the Bureau of Health Services Financing. The execution of provider
					 agreement and the assignment of the provider's Medicaid vendor number is
					 contingent upon the following criteria.
1.
					 The facility shall request a Medicaid enrollment packet from the BHSF/HSS
					 Provider Enrollment Unit. The information listed below shall be returned as
					 soon as it is completed.
a. Two copies of the
					 provider agreement form which shall bear the signature of the person legally
					 designated to enter into the contract with DHH;
b. One copy of the provider enrollment form,
					 PE 50, which shall be completed in accordance with accompanying instructions
					 and bear the signature of the administrator or authorized
					 representative;
c. An addendum to
					 the above provider agreement shall be completed if the facility chooses to
					 provide any of the following enhanced levels of care:
i. a skilled-infectious disease
					 (S-ID);
ii. skilled-technology
					 dependent care (S-TDC);
iii.
					 skilled/neurological rehabilitation treatment program (S-NRTP).
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 101 - Standards for Payment for Nursing Facilities › Subchapter B - General Provisions › Section II-10107 - Change in Ownership

Current through Register Vol. 50, No. 6, June 20, 2024
A. Assignment
					 of Agreement
1. As a temporary measure during
					 a change of ownership, the Bureau of Health Services Financing-Health Standards
					 Section shall automatically assign the provider agreement and certification to
					 the new owner. The new owner shall comply with all participation prerequisites
					 simultaneously with the ownership transfer. Failure to promptly comply with
					 these prerequisites may result in the interruption in vendor payment. The new
					 owner shall be required to complete a new provider enrollment
					 application.
2. Such an assignment
					 is subject to all applicable statutes, regulations, terms, and conditions under
					 which it was originally issued including, but not limited to, the following:
a. any existing corrective action
					 plan;
b. any expiration
					 date;
c. compliance with applicable
					 health and safety standards;
d.
					 compliance with the ownership and financial interest disclosure
					 requirements;
e. compliance with
					 civil rights requirements;
f. any
					 facility need review rules that are applicable;
g. compliance with any additional
					 requirements imposed by the Bureau of Health Services Financing, Health
					 Services Section.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 101 - Standards for Payment for Nursing Facilities › Subchapter B - General Provisions › Section II-10109 - Withdrawal from the Medicaid Program

Current through Register Vol. 50, No. 6, June 20, 2024
A. A facility may involuntarily or
					 voluntarily lose its participating status in the Medicaid Program. When a
					 facility loses its participating status in the Medicaid Program, a minimum of
					 ten percent of the final vendor payment to the facility is withheld pending the
					 fulfillment of the following requirements:
1.
					 completion of a limited scope audit of the residents' funds account and the
					 disposition requirements for nurse aide training funds with findings and any
					 recommendations of a qualified accountant of the facility's choice submitted to
					 the BHSF Institutional Reimbursement Section. The facility has 60 days to
					 submit the audit findings to the BHSF Institutional Reimbursement Section once
					 the section notifies the facility that a limited scope audit is required.
					 Failure of the facility to comply is considered a class E violation and will
					 result in fines as outlined in the Subchapter L entitled sanctions;
2. the facility's compliance with the
					 recommendations of the limited scope audit and the disposition requirements for
					 nurse aide training funds;
3.
					 submittal of an acceptable final cost report by the facility to BHSF Program
					 Operations Section.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 101 - Standards for Payment for Nursing Facilities › Subchapter C - Administration › Section II-10111 - Introduction

Current through Register Vol. 50, No. 6, June 20, 2024
A. A facility shall
					 be administered in a manner that enables it to use its resources effectively
					 and efficiently to attain or maintain the highest practicable physical, mental,
					 and psychosocial well-being of each resident. It shall be responsible for
					 ensuring that all services provided to the residents by professional staff meet
					 ethical and professional standards governing the profession.
B. Licensure. A facility must be licensed
					 under applicable state and local laws.
C. Compliance with Federal, State, and Local
					 Laws and Professional Standards. The facility must operate and provide services
					 in compliance with all applicable federal, state and local laws, regulations
					 and codes, and with accepted professional standards and principles that apply
					 to professionals providing services in such a facility.
D. Relationship to Other HSS Regulations. In
					 addition to compliance with the regulations set forth in this sub-part,
					 facilities are obliged to meet the applicable provisions of other HSS
					 regulations, including but not limited to those pertaining to:
1. nondiscrimination on the basis of race,
					 color, or national origin (45 CFR page 80);
2. nondiscrimination on the basis of handicap
					 (45 CFR page 84);
3.
					 nondiscrimination on the basis of age ( 45 CFR Part 91);
4. protection of human subjects of research
					 (45 CFR page 46); and
5. fraud and
					 abuse ( 42 CFR Part 455).
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 101 - Standards for Payment for Nursing Facilities › Subchapter C - Administration › Section II-10113 - Infection Control

Current through Register Vol. 50, No. 6, June 20, 2024
A. The facility
					 must establish and maintain an infection control program designed to provide a
					 safe, sanitary, and comfortable environment in which residents reside and to
					 help prevent the development and transmission of disease and infection using
					 Centers for Disease Control guidelines where available.
B. Infection Control Program (ICP). An ICP
					 must be established in the facility which identifies who:
1. investigates, controls, and prevents
					 infections in the facility;
2.
					 decides what procedures, such as isolation, should be applied to an individual
					 resident; and
3. maintains a record
					 of incidents and corrective actions related to infections.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 101 - Standards for Payment for Nursing Facilities › Subchapter D - Resident Care Services › Section II-10117 - Administrative Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. Facility
					 Administrator. All facilities are required to have full-time administrators.
					 "Full-time" administrators are persons who are licensed, currently registered
					 and engaged in the day to day management of the facility. A full-time employee
					 functioning in an administrative capacity shall be authorized in writing to act
					 in the administrator's behalf when he/she is absent or when the administrator
					 is functioning as a full-time administrator for two facilities. The
					 administrator's duties shall conform to the following standards.
1. Administrative/management activities shall
					 be the major function of the duties required. The administrator is responsible
					 for the management of the facility.
2. An adequate and reasonable amount of time
					 shall be spend on the premises of the facility. The activity must be the major
					 functions of the person performing the act.
3. A major portion of the time, referred to
					 above, shall be spent during the normal work week of the facility's
					 personnel.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 101 - Standards for Payment for Nursing Facilities › Subchapter D - Resident Care Services › Section II-10119 - Physician Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. Medical
					 Director. The nursing facility shall have a written agreement with a physician
					 who shall serve as the medical director on a full-time or part-time basis.
					 Whether the physician is employed full-time or part-time shall be based on the
					 residents' needs.
1. The medical director
					 shall not have peer restriction in regard to overseeing total medical
					 care.
2. The medical director is
					 responsible for:
a. implementation of
					 resident care policies; and
b.
					 coordination of medical care in the facility.
3. Residents shall be admitted to a facility
					 only with a physician's order, and medical care shall be under a physician's
					 supervision. Each resident shall have freedom of choice of
					 physicians.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 101 - Standards for Payment for Nursing Facilities › Subchapter D - Resident Care Services › Section II-10121 - Nursing Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. The facility
					 shall provide an organized nursing service with a sufficient number of licensed
					 and unlicensed qualified nursing personnel to meet the total nursing needs of
					 all residents in accordance with the resident care policies of the facility on
					 a 24 hour basis.
1. The facility shall
					 provide:
a. policies that are designed to
					 ensure that each resident:
i. receives
					 treatments, medications, diets as prescribed, rehabilitative nursing care as
					 needed;
ii. receives care to
					 prevent pressure sores and deformities;
iii. is kept comfortable, clean, and
					 well-groomed;
iv. is protected from
					 accident, injury, and infection; and
v. is encouraged, assisted, and trained in
					 self-care and group activities.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 101 - Standards for Payment for Nursing Facilities › Subchapter D - Resident Care Services › Section II-10123 - Comprehensive Assessment

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
					 facility must conduct initially and periodically a comprehensive, accurate,
					 standardized, reproducible assessment of each resident's functional capacity
					 and needs, in relation to a number of specified areas. Comprehensive
					 assessments must:
1. be based on a uniform
					 data set (resident assessment instrument); and
2. describe the resident's capability to
					 perform daily life functions and significant impairments in functional
					 capacity;
3. include the following
					 information:
a. medically defined conditions
					 and prior medical treatment;
b.
					 medical status measurements;
c.
					 physical and mental functional status;
d. sensory and physical
					 impairments;
e. nutritional status
					 and requirements;
f. special
					 treatment and procedures;
g. mental
					 and psychosocial status;
h.
					 discharge potential;
i. dental
					 condition;
j. activities
					 potential;
k. rehabilitation
					 potential;
l. cognitive status;
					 and
m. drug therapy.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 101 - Standards for Payment for Nursing Facilities › Subchapter D - Resident Care Services › Section II-10125 - Comprehensive Care Plan

Current through Register Vol. 50, No. 6, June 20, 2024
A. Basis for
					 the Comprehensive Care Plan. All services in a facility shall be provided in
					 accordance with a physician's written order which shall be developed either
					 before admission or before authorization for payment. The facility must develop
					 a comprehensive care plan for each resident that includes measurable objectives
					 and timetables to meet a resident's medical, nursing, and psychosocial needs
					 that are identified in the comprehensive assessment.
1. The comprehensive assessment shall be
					 developed for residents within 14 days of admission. Written comprehensive care
					 plans shall be developed within seven days of the comprehensive assessment and
					 no later than 21 days of admission. Thereafter, care plans must be updated at
					 least quarterly or when a significant change in the resident's condition
					 occurs.
2. Individual comprehensive
					 care plans shall:
a. be prepared by an
					 interdisciplinary (ID) team that includes the attending physician, a registered
					 nurse with responsibility for the resident, and other appropriate staff in
					 disciplines as determined by the resident's needs;
b. include the resident, resident's family or
					 legal representative, to the extent practicable in the participation of the
					 care planning process;
c. be
					 periodically reviewed and revised by a team of qualified persons after each
					 assessment and/or quarterly review. This requirement is a review for both ICF
					 and SNF. Neurological Rehabilitative Treatment Program (NRTP) levels of care
					 shall be reviewed every 30 days;
d.
					 be located in the medical record and accessible for use by all licensed nursing
					 personnel and any staff directly involved in the integrated care;
e. serve as the primary communication tool
					 among disciplines to ensure that services are coordinated and that the
					 approaches of the various disciplines are integrated;
f. be written in a language understandable to
					 all staff directly involved in the resident's care and the resident in so far
					 as possible; and
g. document that
					 all services ordered are being rendered and properly recorded.
3. Documentation of quarterly
					 staffing must be on the MDS quarterly Review Form as a comparable computerized
					 document. The documentation shall indicate the date of the staffing and who was
					 in attendance.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 101 - Standards for Payment for Nursing Facilities › Subchapter D - Resident Care Services › Section II-10127 - Pharmacy Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. The facility
					 must arrange for the provision of pharmaceutical services including procedures
					 that assure the accurate acquiring, receiving, dispensing, and administering of
					 all drugs and biologicals to meet the needs of each resident. Prescription
					 drugs not covered by Medicaid or Medicare shall be at the expense of the
					 resident. However, every attempt should be made to get the attending physician
					 to order a covered medication before the resident incurs any expense.
1. The facility shall provide routine and
					 emergency drugs and biologicals to its residents, or obtain them under an
					 agreement with an outside resource.
2. The arrangement/agreement with an outside
					 resource shall specify in writing that the facility assumes responsibility for:
a. obtaining services that meet professional
					 standards and principles that apply to professionals providing services in such
					 a facility; and
b. the timeliness
					 of the service.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 101 - Standards for Payment for Nursing Facilities › Subchapter D - Resident Care Services › Section II-10129 - Dietetic Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. A designated
					 full-time staff member suited by training and experience in food management and
					 nutrition shall be responsible for supervision of dietary services. If the
					 designated staff member is not a qualified dietitian, he/she shall serve as the
					 dietary manager an10129. Dietetic Servicesd shall function with frequent,
					 regularly scheduled consultation from a person who is a qualified dietitian. A
					 minimum consultation time shall be not less than eight hours per month and as
					 needed to ensure nutrition needs of residents are addressed timely. A copy of
					 the consultant's contract shall be available to the State Survey Agency for
					 review. In addition, the facility shall employ sufficient supportive personnel
					 competent to carry out the functions of the dietetic service. Food service
					 personnel shall be on duty daily for a period of 12 or more continuous
					 hours.
B. Dietitian
1. The facility shall employ a qualified
					 dietician either full-time, part-time or on a consultant basis.
2. If a qualified dietician is not employed
					 full time, the facility shall designate a person to serve as the dietary
					 manager.
3. A qualified dietician
					 is one who is qualified based upon registration by the Commission on Dietetics
					 of the American Dietetic Association and licensure by the Louisiana Board of
					 Examiners in Dietetics and Nutrition.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 101 - Standards for Payment for Nursing Facilities › Subchapter D - Resident Care Services › Section II-10131 - Social Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. A NF with
					 more than 120 beds must employ a full-time qualified social service director
					 with the following qualifications:
1. a
					 bachelor's degree in social work or a bachelor's degree in a human services
					 field including but not limited to sociology, special education, rehabilitation
					 counseling, and psychology; and
2.
					 one year of supervised social work experience in a health care setting working
					 directly with individuals; or
3. a
					 similar professional degree in a field such as counseling, special education,
					 sociology, or psychology.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 101 - Standards for Payment for Nursing Facilities › Subchapter D - Resident Care Services › Section II-10133 - Activity Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. The facility
					 shall provide an ongoing activities program designed to stimulate and promote
					 the physical, social, emotional, and intellectual well-being of each resident
					 and encourage normal activity and return to self care.
B. Resident Activity Director. The facility's
					 activities program shall be under the direction of the resident activity
					 director (RAD).
1. The nursing facility shall
					 have at least one RAD. An additional RAD per resident census in excess of 100
					 shall be required. The RAD employees shall be full-time or sufficient full-time
					 equivalent employees shall be maintained to comply with these standards.
					 Regardless of the number of RAD employees required, one full-time RAD shall be
					 certified.
2. Responsibilities of
					 the RAD include the following tasks:
a.
					 scheduling and coordinating group activities and special events inside and
					 outside the facility;
b. developing
					 and using outside resources and actively recruiting volunteers to enhance and
					 broaden the scope of the activities program;
c. posting monthly activity calendars in
					 places where applicants/residents and staff can easily see them;
d. planning and implementing individual and
					 group activities designed to meet the applicants/residents' needs and
					 interests.
3. A resident
					 activity director may be one of the following individuals:
a. a qualified therapeutic recreation
					 specialist:
i. who is certified with the
					 National Council on Therapeutic Recreation Certification; and
ii. eligible for certification as therapeutic
					 recreation specialist by a recognized accrediting body on August 1,
					 1989;
b. a person having
					 the following experience:
i. two years of
					 experience in a social or recreational program within the last five
					 years;
ii. one year of the
					 experience shall have been gained as a full-time employee in a health care
					 setting involving resident activities programs;
c. a qualified occupational therapist or
					 occupational therapy assistant;
d.
					 An individual who has completed a training course approved by the
					 Department.
e. An individual who is
					 enrolled in a training course approved by the department.
NOTE: Prior to the effective date of this document the
						Resident Activity Director (RAD) was referred to as Patient Activities
						Coordinator (PAC) or Patient Activity Director (PAD).
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 101 - Standards for Payment for Nursing Facilities › Subchapter D - Resident Care Services › Section II-10135 - Medical Records

Current through Register Vol. 50, No. 6, June 20, 2024
A. The facility
					 shall maintain medical records which include clinical, medical, and
					 psychosocial information on each resident.
1.
					 These records must be:
a. complete;
b. accurately documented;
c. readily accessible; and
d. systematically organized.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 101 - Standards for Payment for Nursing Facilities › Subchapter D - Resident Care Services › Section II-10137 - Ancillary Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. Dental
					 Services
1. The facility shall assist
					 residents in obtaining routine and 24 hour emergency dental care to meet needs
					 of each resident.
2. Routine dental
					 services are defined as including dentures, relines and repairs to dentures,
					 and some oral surgeries. Medicaid residents may be charged for dental services
					 which are not covered services, i.e., extraction, fillings, etc. For residents
					 who are unable to pay for needed dental services, the facility should attempt
					 to find alternative funding sources or alternative service delivery
					 systems.
3. The facility shall, if
					 necessary, assist the resident in making appointments and arranging for
					 transportation to and from the dentist office.
4. The facility is responsible for promptly
					 referring residents with lost or damaged dentures to a dentist who participates
					 in the Medicaid Program.
5. The
					 Medicaid participating dentist should be contacted to give specific information
					 as to what dental services are Medicaid-covered services, when prior approval
					 is necessary, and what dental procedures are not reimbursable by
					 Medicaid.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 101 - Standards for Payment for Nursing Facilities › Subchapter D - Resident Care Services › Section II-10139 - Hospice Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. Effective
					 July 1, 1993, a Louisiana nursing facility (NF) resident who is eligible for
					 both Medicare and Medicaid can elect the Medicare hospice benefit if the
					 nursing facility is being or will be reimbursed for the resident's care by
					 Medicaid.
B. Hospice care focuses
					 on assuring the quality of the terminal resident's remaining life rather than
					 on trying to prolong the length of that life. It is a program of palliative
					 (control of pain and symptoms) and supportive services which provides physical,
					 psychological, social and spiritual care for dying persons and
					 families.
C. Hospice Admission
					 Criteria
1. Resident is enrolled in Medicare
					 Part A and is Medicaid eligible or in applicant status.
2. A prognosis of six months or less
					 confirmed by the attending physician. The prognosis of the terminal illness
					 must be in terms of days, weeks, or months.
3. Election of the hospice benefit must be
					 made by the competent resident or family member in the order described by
					 Louisiana law for the non-competent resident.
4. Care goal must be palliative and not
					 curative.
5. Resident shall be
					 under the care of an attending physician who consents to the Hospice admission
					 and who will continue to assume responsibility for medical care.
6. The resident lives in a nursing facility
					 within the Hospice service area.
7.
					 Final determination of medical eligibility for admission to hospice is made by
					 the Health Standards Section of the Bureau of Health Services
					 Financing.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 101 - Standards for Payment for Nursing Facilities › Subchapter F - Vendor Payments › Section II-10147 - General Provisions

Current through Register Vol. 50, No. 6, June 20, 2024
A.
					 Residents Receiving Care Under Title XIX (Medicaid) Only
1. The BHSF Medicaid Program shall determine
					 the resident's applicable income (liability when computing facility vendor
					 payments. Vendor payments are subject to the following conditions.
a. Vendor payments shall begin with the first
					 day the resident is determined categorically and medically eligible or the date
					 of admission, if later.
b. Vendor
					 payments shall be made as determined by the facility per diem rate less the
					 resident's per diem applicable income for the number of eligible
					 days.
c. If a resident transfers
					 from one facility to another, the vendor payments to each facility is the
					 facility's per diem rate for the number of days in the facility, less the
					 resident's per diem applicable income for the total number of days in each
					 facility.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 101 - Standards for Payment for Nursing Facilities › Subchapter F - Vendor Payments › Section II-10151 - Cost Reports

Current through Register Vol. 50, No. 6, June 20, 2024
A. Initial Cost
					 Report. The initial cost report submitted by all providers of Long Term Care
					 services under the Medicaid Program shall be based on the most recent fiscal
					 year end.
1. An exception to the initial cost
					 report requirement may be recognized on an individual basis upon request by the
					 provider prior to the due date. If an exception is allowed, the provider shall
					 attach to the cost report a statement fully describing the nature of the
					 exception for which written permission was requested and granted.
2. For the initial reporting period only, the
					 provider may allocate costs to the various cost centers on a reasonable basis
					 if the required departmental cost breakdown is not available.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 101 - Standards for Payment for Nursing Facilities › Subchapter F - Vendor Payments › Section II-10153 - Audits, Inspections, Reviews

Current through Register Vol. 50, No. 6, June 20, 2024
A.
					 General. Facilities shall be subject to audits, inspections of the quality of
					 care provided, and review of each applicant/recipient's need for SN-NRTP,
					 SN-TDC, SN-ID, SN, IC I, or IC II services.
B. Audits. All nursing facility providers
					 participating in the Medicaid Program shall be subject to audit. A sufficient
					 representative sample of each type of Long Term Care provider shall be fully
					 audited to ensure the fiscal integrity of the program and compliance with
					 program regulations governing reimbursement. Limited scope and exception audits
					 shall be conducted as needed. The facility shall retain such records or file as
					 required by the Department of Health and Hospitals-Bureau of Health Services
					 Financing and shall have them available for inspection for three years from the
					 date of service or until all audit exceptions are resolved, whichever period is
					 longer.
NOTE: If the department's limited scope audit of the
						residents' Personal funds account indicate a material number of transactions
						were not sufficiently supported or material non-compliance, the department
						shall initiate a full scope audit of the account. The cost of the full scope
						audit shall be withheld from the vendor payments. (Refer to Subchapter L,
						Sanctions and Appeal Procedures.)
AUTHORITY NOTE:
						Promulgated in accordance with
						R.S.
						46:153.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 101 - Standards for Payment for Nursing Facilities › Subchapter G - Levels of Care › Section II-10154 - Nursing Facility Level of Care Determinations

Current through Register Vol. 50, No. 6, June 20, 2024
A. The purpose of the level of care (LOC)
					 determination is to assure that individuals meet the functional and medical
					 necessity requirements for admission to and continued stay in a nursing
					 facility. In addition, the LOC determination process assists persons with
					 long-term or chronic health care needs in making informed decisions and
					 selecting options that meet their needs and reflect their
					 preferences.
B. In order for an
					 individual to meet nursing facility level of care (NFLOC), functional and
					 medical eligibility must be met as set forth and determined by the Office of
					 Aging and Adult Services (OAAS). The functional and medical eligibility process
					 is frequently referred to as the "nursing facility level of care
					 determination."
C. OAAS shall
					 utilize prescribed screening and assessment tools to gather evaluation data for
					 the purpose of determining whether an individual has met the nursing facility
					 level of care requirements as set forth in this Subchapter.
D. Individuals who are approved by OAAS, or
					 its designee, as having met NFLOC must continue to meet medical and functional
					 eligibility criteria on an ongoing basis.
E. A LOC screening conducted via telephone
					 shall be superseded by a face-to-face LOC assessment, or audit review LOC
					 determination as determined by OAAS or its designee.
F. If on an audit review or other subsequent
					 face-to-face LOC assessment, the LOC findings are determined to be incorrect or
					 it is found that the individual no longer meets level of care, the audit or
					 subsequent face-to-face LOC assessment findings will prevail.
G. The department may require applicants to
					 submit documentation necessary to support the nursing facility level of care
					 determination.
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 II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 101 - Standards for Payment for Nursing Facilities › Subchapter G - Levels of Care › Section II-10155 - Standards for Levels of Care

Current through Register Vol. 50, No. 6, June 20, 2024
A.
					 Classifications of care are established to ensure placement of residents in
					 Long Term Care Facilities with available and appropriate resources to meet
					 their social psychological, psychological, and biophysical needs.
B. Classifications of care are established
					 with consideration of the resident as a person with innate dignity and worth as
					 a human being.
C. Classifications
					 of care are defined and established so that a resident's total needs, the
					 complexity of the services rendered, and the time required to render these
					 services be assessed in determining placement.
D. Classifications of care are established to
					 prevent placement of residents in facilities where they would present a danger
					 to themselves or other residents.
E. Classifications of care are established to
					 maintain health care so residents achieve a reasonable recovery, maintain a
					 current level of wellness, or experience minimal health status
					 deterioration.
F. Facility
					 Submission of Data. Evaluative data for medical certification for IC I, IC II,
					 and SNF levels of care shall be submitted to the appropriate Bureau of Health
					 Services Financing-Health Standards, Admission Review Unit. This includes data
					 for the following situations:
1. initial
					 applications and reapplication;
2.
					 applications for residents already in long term care facilities;
3. transfers of residents from one level to
					 another;
4. transfer of residents
					 between facilities; and
5.
					 applications for residents who are residents in a mental health facility.
a. All applicants for admission to a nursing
					 facility must be screened for indications of mental illness or mental
					 retardation prior to admission to the nursing facility. This is done by
					 submitting the information requested on Forms 90-L and PASARR-1.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 101 - Standards for Payment for Nursing Facilities › Subchapter G - Levels of Care › Section II-10156 - Level of Care Pathways

Current through Register Vol. 50, No. 6, June 20, 2024
A. Several
					 potential avenues of functional and medical eligibility shall be investigated
					 by OAAS. These avenues are called pathways. The pathways are utilized to ensure
					 consistency, uniformity, and reliability in making nursing facility level of
					 care determinations. In order to meet the nursing facility level of care, an
					 individual must meet eligibility requirements in only one pathway.
B. When specific eligibility criteria are met
					 within a pathway, that pathway is said to have triggered. The Medicaid program
					 defines nursing facility level of care for Medicaid eligible individuals as the
					 care required by individuals who meet or trigger any one of the established
					 level of care pathways described in this Subchapter. The pathways of
					 eligibility focus on information used to determine if an individual has met or
					 triggered a level of care pathway. When a pathway is triggered, that individual
					 may be approved for a limited stay/length of service as deemed appropriate by
					 OAAS.
C. The level of care
					 pathways elicit specific information, within a specified time period, regarding
					 the individual's:
1. functional
					 capabilities;
2. receipt of
					 assistance with activities of daily living (ADL);
3. current medical treatments and conditions;
					 and
4. other aspects of an
					 individual's life.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 101 - Standards for Payment for Nursing Facilities › Subchapter I - Resident Rights › Section II-10161 - General Provisions

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
					 resident has a right to a dignified existence, self-determination, and
					 communication with and access to persons and services inside and outside the
					 facility. A facility must protect and promote the rights of each
					 resident.
B. Exercise of Rights
1. The resident has the right to exercise his
					 or her rights as a resident of the facility and as a citizen or resident of the
					 United States.
2. The resident has
					 the right to be free of interference, coercion, discrimination, and reprisal
					 from the facility in exercising his or her rights.
3. In the case of a resident adjudged
					 incompetent under the laws of a state by a court of competent jurisdiction, the
					 rights of the resident are exercised by the person appointed under state law to
					 act on the resident's behalf.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 101 - Standards for Payment for Nursing Facilities › Subchapter J - Transfer and Discharge Procedures › Section II-10163 - General Provisions

Current through Register Vol. 50, No. 6, June 20, 2024
A. Health
					 facilities must permit each resident to remain in the facility and not transfer
					 or discharge the resident from the facility unless:
1. the transfer or discharge is necessary for
					 the resident's welfare and the resident's needs cannot be met in the
					 facility;
2. the transfer or
					 discharge is appropriate because the resident's health has improved
					 sufficiently so that the resident no longer needs the services provided by the
					 facility;
3. the safety of
					 individuals in the facility is endangered;
4. the health of individuals in the facility
					 would otherwise be endangered;
5.
					 the resident has failed, after reasonable and appropriate notice, to pay for
					 (or to have paid under Medicare or Medicaid) a stay at the facility;
					 and
6. the facility ceases to
					 operate.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 101 - Standards for Payment for Nursing Facilities › Subchapter K - Complaint Procedures › Section II-10165 - Purpose and Scope

Current through Register Vol. 50, No. 6, June 20, 2024
A. Under the
					 provisions of Louisiana
					 R.S.
					 40:2009.2 through 2009.20 and State
					 Operations Manual as published by the Department of Health and Hospitals and
					 Health Care Financing Administration, the following procedures are established
					 for receiving, evaluating, investigating, and correcting grievances pertaining
					 to resident care in licensed and certified nursing facilities. The following
					 procedures also provide mandatory reporting of abuse and neglect in nursing
					 facilities.
B. Applicability
1. Any person having knowledge of the alleged
					 abuse or neglect of a resident or knowledge of a resident being denied care and
					 treatment may submit a complaint, preferably in writing.
2. Any person may submit a complaint if
					 he/she has knowledge that a state law, standard, rule, regulation, correction
					 order, or certification rule issued by the Department of Health and Hospitals
					 has been violated.