reglab/statecodes huggingface dataset:
Louisiana Administrative Code › Title 49 - PUBLIC HEALTH-FOOD, DRUGS, AND COSMETICS › Part I - Regulations › Chapter 13 - Tanning Facility Regulations › Section I-1327 - Tanning Equipment Standards [formerly 49:8.0130]

Current through Register Vol. 50, No. 6, June 20, 2024
A. Equipment used in tanning facilities shall
				conform to the standards set forth in
				R.S. 40:2711(A)
				through (D) as well as the following.
1. Tanning equipment booths or rooms shall be
				of rigid construction.
2. Wall
				surfaces within booths or rooms shall be easily cleanable and shall be kept
				clean at all times.
3. Ceilings,
				where provided, shall be easily cleanable and shall be kept clean.
4. Floors within tanning equipment booths or
				rooms shall be constructed of readily cleanable materials including, but not
				limited to, vinyl tile, sheet vinyl, quarry tile, glazed brick, short pile
				carpet or rugs, or other suitable material.
5. Floors shall be kept clean and in good
				repair at all times.
Louisiana Administrative Code › Title 49 - PUBLIC HEALTH-FOOD, DRUGS, AND COSMETICS › Part I - Regulations › Chapter 13 - Tanning Facility Regulations › Section I-1329 - Requirements for Stand-Up Booths [formerly 49:8.0140]

Current through Register Vol. 50, No. 6, June 20, 2024
A. Tanning booths designed for stand-up use
				shall also comply with the requirements of
				R.S.
				40:2712.
AUTHORITY NOTE:
				  Promulgated in accordance with R.S.
				  40:2701-2719.
Louisiana Administrative Code › Title 49 - PUBLIC HEALTH-FOOD, DRUGS, AND COSMETICS › Part I - Regulations › Chapter 13 - Tanning Facility Regulations › Section I-1331 - Potable Water Supply; Sanitary Facilities; Sewage and Waste Disposal [formerly 49:8.0150]

Current through Register Vol. 50, No. 6, June 20, 2024
A. Each
				tanning facility shall provide an ample supply of potable hot and cold water,
				under pressure for drinking, cleansing, washing or other purposes. Such water
				supply shall not be cross connected to any other supply.
B. Each tanning facility shall provide toilet
				and hand washing facilities according to requirements of Part XIV, Table 411 of
				the state
Sanitary Code
and each toilet shall be furnished
				with toilet tissue. The facilities shall be maintained in a sanitary condition
				and kept in good repair at all times. Doors to toilet rooms shall be
				self-closing. Toilet rooms shall be well lighted and ventilated.
C. Sewage disposal shall be made in a sewage
				system or by other means approved by the State Health Officer.
AUTHORITY NOTE:
				  Promulgated in accordance with R.S.
				  40:2701-2719.
Louisiana Administrative Code › Title 49 - PUBLIC HEALTH-FOOD, DRUGS, AND COSMETICS › Part I - Regulations › Chapter 13 - Tanning Facility Regulations › Section I-1333 - Rubbish and Trash Disposal [formerly 49:8.0160]

Current through Register Vol. 50, No. 6, June 20, 2024
A. Rubbish, trash, and other debris including
				used or burned out tanning lamps shall be so conveyed, stored and disposed of
				as to minimize the development of odor and to prevent harborage of
				vermin.
AUTHORITY NOTE:
				  Promulgated in accordance with R.S.
				  40:2701-2719.
Louisiana Administrative Code › Title 49 - PUBLIC HEALTH-FOOD, DRUGS, AND COSMETICS › Part I - Regulations › Chapter 13 - Tanning Facility Regulations › Section I-1335 - Operational Requirements [formerly 49:8.0170]

Current through Register Vol. 50, No. 6, June 20, 2024
A. Each tanning facility must be operated
				under the requirements set forth by
				R.S.
				40:2713.
B. Each tanning facility shall establish and
				adhere to effective procedures for cleaning and sanitizing each tanning bed or
				booth as well as protective eyewear before and after use of such equipment by
				each consumer.
AUTHORITY NOTE:
				  Promulgated in accordance with R.S.
				  40:2701-2719.
Louisiana Administrative Code › Title 49 - PUBLIC HEALTH-FOOD, DRUGS, AND COSMETICS › Part I - Regulations › Chapter 13 - Tanning Facility Regulations › Section I-1337 - Information Provided to Consumers, Warnings [formerly 49:8.0180]

Current through Register Vol. 50, No. 6, June 20, 2024
A. Each tanning
				facility operator shall provide each consumer, prior to initial exposure, a
				written warning statement as required by
				R.S.
				40:2714(A). Such warning
				statements shall be signed by each consumer and maintained permanently on file
				at the tanning facility. A copy of the signed warning statement shall be given
				to each consumer. Copies of such warning statement shall be available for
				review during inspections by duly authorized agents of the state health
				officer. The written warning statement shall warn that:
1. failure to use eye protection provided to
				the customer by the tanning facility may result in damage to the
				eyes;
2. overexposure to
				ultraviolet light causes burns;
3.
				repeated exposure may result in premature aging of the skin and skin
				cancer;
4. abnormal skin
				sensitivity or burning may be caused by reactions of ultraviolet light to
				certain:
a. foods;
b. cosmetic;
c. medications, including tranquilizers,
				diuretics, antibiotic, high blood pressure medicines, and oral
				contraceptives;
5. any
				person taking a prescription or over-the-counter drug should consult a
				physician before using a tanning device;
6. a person should not sunbathe before or
				after exposure to ultraviolet radiation from sunlamps.
Louisiana Administrative Code › Title 49 - PUBLIC HEALTH-FOOD, DRUGS, AND COSMETICS › Part I - Regulations › Chapter 13 - Tanning Facility Regulations › Section I-1339 - Reports to the Department [formerly 49:8.0190]

Current through Register Vol. 50, No. 6, June 20, 2024
A. The registrant shall submit to the
				department a written report of actual or alleged injury from the use of
				registered tanning equipment within five working days after occurrence or
				notice thereof as required by
				R.S.
				40:2714(D). The report shall
				include:
1. the name of the affected
				individual;
2. the name, location,
				and number of the certificate of registration-permit for the tanning facility
				and identification of the specific tanning equipment involved, including the
				name, model number, date of manufacture and type of lamp(s);
3. the nature of the actual or alleged
				injury, as well as the complete name, address and telephone number of any
				doctor visited for medical attention;
5. any other information relevant to the
				actual or alleged injury, including the date and duration of
				exposure.
Louisiana Administrative Code › Title 49 - PUBLIC HEALTH-FOOD, DRUGS, AND COSMETICS › Part I - Regulations › Chapter 13 - Tanning Facility Regulations › Section I-1341 - Replacement of Ultraviolet Lamps, Bulbs, Filters [formerly 49:8.0210]

Current through Register Vol. 50, No. 6, June 20, 2024
A. Defective and
				burned out lamps, bulbs, or filters shall be replaced in accordance with
				R.S.
				40:2714(F) and
				(G).
AUTHORITY NOTE:
				  Promulgated in accordance with R.S.
				  40:2701-2719.
Louisiana Administrative Code › Title 49 - PUBLIC HEALTH-FOOD, DRUGS, AND COSMETICS › Part I - Regulations › Chapter 13 - Tanning Facility Regulations › Section I-1343 - Tanning Equipment Operator Training [formerly 49:8.0220]

Current through Register Vol. 50, No. 6, June 20, 2024
A. The registrant
				shall certify that all tanning equipment operators are adequately trained in at
				least the following:
1. the requirements of
				these regulations;
2. procedures
				for correct operation of the tanning facility and tanning equipment;
3. recognition of injury or overexposure to
				ultraviolet radiation;
4. the
				tanning equipment manufacturers procedures for operation and maintenance of the
				tanning equipment;
5. the
				determination of skin type of consumers and appropriate determination of
				duration of exposure to registered tanning equipment;
6. emergency procedure to be followed in case
				of injury.
Louisiana Administrative Code › Title 49 - PUBLIC HEALTH-FOOD, DRUGS, AND COSMETICS › Part I - Regulations › Chapter 13 - Tanning Facility Regulations › Section I-1345 - Inspections by Department [formerly 49:8.0230]

Current through Register Vol. 50, No. 6, June 20, 2024
A. In order to effect the enforcement of
				these regulations, officers or employees duly authorized by the department or
				the state health officer, after making reasonable request, may enter any
				registered or unregistered tanning facility and inspect all tanning booths,
				rooms, tanning equipment, tanning devices, consumer records, and any other
				materials used in the tanning facility.
B. No tanning facility registrant, owner, or
				operator shall refuse this reasonable inspection request, without being
				subjected to provisions of §1321. A.4 of these regulations.
AUTHORITY NOTE:
				  Promulgated in accordance with R.S.
				  40:2701-2719.
Louisiana Administrative Code › Title 49 - PUBLIC HEALTH-FOOD, DRUGS, AND COSMETICS › Part I - Regulations › Chapter 13 - Tanning Facility Regulations › Section I-1347 - Penalties; Criminal Penalty; Injunction [formerly 49:8.0240]

Current through Register Vol. 50, No. 6, June 20, 2024
A. Criminal
				penalties or injunctions may be imposed upon a tanning facility operator as
				provided by 40:2716 and 40:2717 of the Act.
AUTHORITY NOTE:
				  Promulgated in accordance with R.S.
				  40:2701-2719.
Louisiana Administrative Code › Title 49 - PUBLIC HEALTH-FOOD, DRUGS, AND COSMETICS › Part I - Regulations › Chapter 13 - Tanning Facility Regulations › Section I-1349 - Communications with the Department, Department Address [formerly 49:8.0250] (Repealed)

Current through Register Vol. 50, No. 6, June 20, 2024
AUTHORITY NOTE:
				  Promulgated in accordance with R.S.
				  40:2701-2719.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part I - Administration › Subpart 1 - General Provisions › Chapter 1 - Administrative Procedures › Section I-103 - Employee Criminal History Records Checks

Current through Register Vol. 50, No. 6, June 20, 2024
A. Pursuant to Act 147 of the 2017 Regular
				  Session of the Louisiana Legislature, the Department of Health (the
				  "department") shall perform criminal history records checks of current and
				  prospective employees, contractors or subcontractors, within the Medicaid
				  eligibility section, that have access to federal tax information (FTI) and/or
				  criminal history record information.
1. In
				  compliance with the requirements of R.S. 15.587.5, current or prospective
				  employees, contractors or subcontractors within the Medicaid eligibility
				  section shall be required to submit to a criminal history records check to be
				  conducted by the Louisiana Bureau of Criminal Identification and Information.
a. Fingerprints and other identifying
				  information shall be submitted to the Louisiana Bureau of Criminal
				  Identification and Information by the current or prospective employee,
				  contractor or subcontractor.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part I - Administration › Subpart 1 - General Provisions › Chapter 1 - Administrative Procedures › Section I-105 - Tribal Consultation Process

Current through Register Vol. 50, No. 6, June 20, 2024
A. Pursuant to
				  §1902(a)(73) and
				  §2107(e)(I) of the Social
				  Security Act, the Medicaid Program hereby establishes a process to seek advice
				  on a regular, ongoing basis from designees of the states federally-recognized
				  Indian tribal organizations and Indian health programs about Medicaid and
				  Childrens Health Insurance Program matters that may have a direct impact on
				  Indian health programs and tribal organizations.
B. The department shall comply with the
				  technical requirements for providing verification of the tribal consultation
				  process to the U.S. Department of Health and Human Services, Centers for
				  Medicare and Medicaid Services (CMS) when changes to the Medicaid Program are
				  submitted through:
1. state plan
				  amendments;
2. waivers, including:
a. newly proposed submissions;
b. amendments;
c. extensions;
c. renewals; and
d. waiver terminations.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part I - Administration › Subpart 1 - General Provisions › Chapter 3 - Experimental Procedures › Section I-303 - Coverage

Current through Register Vol. 50, No. 6, June 20, 2024
A. Louisiana
				  Medicaid does not cover any Federal Drug Administration (FDA) designated
				  experimental or investigational medical procedures or devices until those
				  procedures or devices have received final FDA approval or when a procedure or
				  device is specifically approved for coverage by the Medicaid
				  director.
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 I - Administration › Subpart 1 - General Provisions › Chapter 3 - Experimental Procedures › Section I-305 - Routine Care for Beneficiaries in Clinical Trials

Current through Register Vol. 50, No. 6, June 20, 2024
A. The Medicaid program shall cover routine
				  patient costs for items and services furnished in connection with participation
				  in a qualifying clinical trial in accordance with section 1905(gg) of the
				  Social Security Act.
B. - C.3.
				  Repealed.
AUTHORITY
					 NOTE: Promulgated in accordance with
					 R.S.
					 36:254 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part I - Administration › Subpart 1 - General Provisions › Chapter 5 - Telemedicine/Telehealth › Section I-501 - Introduction

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Telemedicine/telehealth is the use of an interactive audio and video
				  telecommunications system to permit real time communication between a distant
				  site health care practitioner and the beneficiary. There is no restriction on
				  the originating site (i.e., where the beneficiary is located) and it can
				  include, but is not limited to, a healthcare facility, school, or the
				  beneficiary's home.
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 I - Administration › Subpart 1 - General Provisions › Chapter 5 - Telemedicine/Telehealth › Section I-503 - Claim Submissions

Current through Register Vol. 50, No. 6, June 20, 2024
A. Medicaid
				  covered services provided via telemedicine/telehealth shall be identified on
				  claim submissions by appending the appropriate place of service or modifier to
				  the appropriate procedure code, in line with current policy.
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 I - Administration › Subpart 1 - General Provisions › Chapter 5 - Telemedicine/Telehealth › Section I-505 - Emergency Provisions

Current through Register Vol. 50, No. 6, June 20, 2024
A. In the
				  event that the federal or state government declares an emergency or disaster,
				  the Medicaid Program may temporarily cover services provided through the use of
				  an interactive audio telecommunications system, without the requirement of
				  video, if such action is deemed necessary to ensure sufficient services are
				  available to meet beneficiaries' needs.
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 I - Administration › Subpart 1 - General Provisions › Chapter 7 - Out-of-State Services › Section I-701 - Out-of-State Medical Care

Current through Register Vol. 50, No. 6, June 20, 2024
A. Medical
				  claims for out-of-state services are honored when:
1. medical services are needed because of a
				  medical emergency;
2. medical
				  services are needed and the beneficiarys health would be in danger if the
				  beneficiary were required to travel to the beneficiarys state of
				  residence;
3. the state determines,
				  on the basis of medical advice, that the needed medical services, or necessary
				  supplementary resources, are more readily available in the other state;
				  or
4. it is general practice for
				  beneficiaries in a particular locality to use medical resources in another
				  state.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part I - Administration › Subpart 1 - General Provisions › Chapter 9 - Advance Directives › Subchapter A - General Provisions › Section I-901 - Definitions

Current through Register Vol. 50, No. 6, June 20, 2024
Advance Directive
-a written statement of
						instruction in a form recognized under state law relating to the provision of
						medical care in the event of incapacity, including the living will and the
						durable power of attorney for health care.
Durable Power of Attorney for Health
						Care
-a document made in accordance with
Louisiana Civil
						Code
, Act 2985 et seq., designating a person to act on the executing
						person's behalf in making medical treatment decisions.
Health Care Provider
-any health
						maintenance organization, home health agency, hospice, hospital, or nursing
						facility.
Information Concerning Advance
						Directive
-pamphlets on advance directive in Louisiana and preprinted
						advance directive forms.
Living Will
-a written declaration made
						in accordance with
						R.S.
						40:1299.58.3, in which a person provides
						instruction regarding the kinds of life-saving or life-sustaining care and
						treatment that the person does or does not wish to receive in the event of
						incapacitation or terminal illness, including the suspension of nutrition and
						hydration.
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 I - Administration › Subpart 1 - General Provisions › Chapter 9 - Advance Directives › Subchapter A - General Provisions › Section I-903 - Departmental Information Dissemination

Current through Register Vol. 50, No. 6, June 20, 2024
A. The department shall supply all health
					 care providers with information concerning advance directives.
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 I - Administration › Subpart 1 - General Provisions › Chapter 9 - Advance Directives › Subchapter B - Provider Responsibilities › Section I-915 - Provider Information Dissemination

Current through Register Vol. 50, No. 6, June 20, 2024
A. A health care provider shall distribute
					 information concerning advance directives to each person at the time of
					 admission into a facility or upon initiation of services, as follows.
1. A hospital and a nursing facility shall
					 provide the written information at the time the patient/resident is
					 admitted.
2. A hospice program
					 shall provide the written information at the time care commences.
3. A home health agency shall provide the
					 written information before the commencement of home care services.
4. A health maintenance organization or
					 health insuring organization shall provide the written information at the time
					 of enrollment.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part I - Administration › Subpart 1 - General Provisions › Chapter 9 - Advance Directives › Subchapter B - Provider Responsibilities › Section I-917 - Policies and Procedures

Current through Register Vol. 50, No. 6, June 20, 2024
A. Each
					 health care provider shall establish and maintain written policies and
					 procedures regarding advance directives. A health care provider shall maintain
					 these policies and procedures for review by the department during a survey.
					 These policies and procedures must include:
1. a written provision relating to individual
					 rights, under federal and state law/regulation to make decisions concerning
					 medical treatment;
2. the right of
					 a patient to formulate advance directives as defined by the federal and state
					 laws/regulations;
3. provisions
					 providing adequate written notice of individual adult patients (at the time of
					 admission, commencement, or enrollment) concerning patient rights;
4. a copy of existing advance directives in
					 the patient's medical records;
5.
					 documentation of information dissemination as required in §915;
6. documentation in the individual's medical
					 record as to whether the individual has executed an advance
					 directive;
7. a plan for
					 participation in community and staff educational campaigns regarding advance
					 directive by newsletters, articles in local newspapers, local news reports, or
					 commercials; and
8. an assurance of
					 compliance with state law with regard to:
a.
					 informing relevant personnel and networks of health care providers and
					 services;
b. providing information
					 about advance directives;
c.
					 ascertaining existence of advance directives;
d. making reasonable efforts to obtain copies
					 by written request; and
e.
					 transferring copies of advance directives brought in by individuals seeking
					 provider services.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part I - Administration › Subpart 1 - General Provisions › Chapter 9 - Advance Directives › Subchapter B - Provider Responsibilities › Section I-919 - Mentally Incapacitated

Current through Register Vol. 50, No. 6, June 20, 2024
A. If a
					 person is mentally incapacitated at the time of admission to or initiation of
					 service by a health care provider, the health care provider shall disseminate
					 information regarding advance directives to the family or legal representative
					 of the person. When the person's incapacity has been alleviated, the health
					 care provider shall provide the information to the person.
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 I - Administration › Subpart 1 - General Provisions › Chapter 9 - Advance Directives › Subchapter B - Provider Responsibilities › Section I-921 - Previously Executed Advance Directives

Current through Register Vol. 50, No. 6, June 20, 2024
A. Except as provided by
					 R.S.
					 40:1299.58.7(B) and (D),
					 when the health care provider is presented with a copy of a patient's advance
					 directive, the health care provider shall comply with the advance
					 directive.
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 I - Administration › Subpart 1 - General Provisions › Chapter 9 - Advance Directives › Subchapter C - Penalties › Section I-941 - Noncompliance

Current through Register Vol. 50, No. 6, June 20, 2024
A. The department
					 may access provider records to verify documentation of date and time of
					 execution of advance directives. Any inquiry shall be directed to the
					 appropriate staff member. Determination of a violation shall result in a notice
					 of noncompliance.
B. Failure to
					 correct a violation listed in a notice of noncompliance may result in sanctions
					 against the provider imposed by the department and may include exclusion from
					 the Medicare and Medicaid programs.
C. Registration of any complaint shall be
					 processed according to the department's complaint procedure.
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 I - Administration › Subpart 1 - General Provisions › Chapter 11 - Medical Necessity › Section I-1101 - Definition and Criteria

Current through Register Vol. 50, No. 6, June 20, 2024
A. Medically
				  necessary services are defined as those health care services that are in
				  accordance with generally accepted evidence-based medical standards or that are
				  considered by most physicians (or other independent licensed practitioners)
				  within the community of their respective professional organizations to be the
				  standard of care.
B. In order to be
				  considered medically necessary, services must be:
1. deemed reasonably necessary to diagnose,
				  correct, cure, alleviate or prevent the worsening of a condition or conditions
				  that endanger life, cause suffering or pain or have resulted or will result in
				  a handicap, physical deformity or malfunction; and
2. those for which no equally effective, more
				  conservative and less costly course of treatment is available or suitable for
				  the recipient.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part I - Administration › Subpart 1 - General Provisions › Chapter 13 - Prohibition of Provider Steering › Section I-1301 - General Provisions

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Definitions
Health Plan
-any managed care organization
					 (MCO), prepaid inpatient
health plan
(PIHP), prepaid
					 ambulatory
health plan
(PAHP), or primary care case management
					 (PCCM) entity contracted with the Medicaid Program.
Provider
-any Medicaid service
provider
contracted with a health plan and/or enrolled in the
					 Medicaid Program.
Provider Steering
-unsolicited advice or
					 mass-marketing directed at Medicaid recipients by health plans, including any
					 of the entitys employees, affiliated providers, agents, or contractors, that is
					 intended to influence or can reasonably be concluded to influence the Medicaid
					 recipient to enroll in, not enroll in, or disenroll from a particular health
					 plan(s).
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 I - Administration › Subpart 1 - General Provisions › Chapter 13 - Prohibition of Provider Steering › Section I-1303 - Provider Sanctions

Current through Register Vol. 50, No. 6, June 20, 2024
A. First
				  Offense. If the department determines that a provider has participated in
				  provider steering, the department will notify the provider in writing and, at
				  its sole discretion, may impose any of the following sanctions as applicable.
1. If a provider has steered a Medicaid
				  recipient to enroll in a particular managed care health plan, payments to the
				  provider for services rendered to the Medicaid recipient for the time period
				  the recipients care was coordinated by the health plan may be
				  recouped.
2. If a provider has
				  steered a Medicaid recipient to participate in Medicaid fee-for-service,
				  payments to the provider for services rendered to the recipient for the time
				  period the recipients care was paid for through Medicaid fee-for-service may be
				  recouped.
3. A provider may be
				  assessed a monetary sanction of up to $1,000 for each recipient steered to join
				  a particular managed care health plan or to participate in Medicaid
				  fee-for-service. The maximum total penalty per incident shall not exceed
				  $10,000.
4. A provider may be
				  required to submit a letter to the particular Medicaid recipient notifying
				  him/her of the imposed sanction and his/her right to freely choose another
				  participating managed care health plan or, if eligible, participate in Medicaid
				  fee-for-service.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part I - Administration › Subpart 1 - General Provisions › Chapter 13 - Prohibition of Provider Steering › Section I-1305 - Provider Appeal Rights

Current through Register Vol. 50, No. 6, June 20, 2024
A. Informal
				  Hearing
1. A provider who has received a
				  notice of sanction shall be provided with an informal hearing if the provider
				  makes a written request for an informal hearing within 15 days of the mailing
				  of the notice of sanction. The request for an informal hearing must be made in
				  writing and sent in accordance with the instructions contained in the notice of
				  sanction. The time and place for the informal hearing will be provided in the
				  notice scheduling the informal hearing.
2. Following the informal hearing, the
				  department shall inform the provider, by written notice, of the results of the
				  informal hearing. The provider has the right to request an administrative
				  appeal within 30 days of the date on the notice of the informal hearing results
				  that is mailed to the provider.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part I - Administration › Subpart 1 - General Provisions › Chapter 13 - Prohibition of Provider Steering › Section I-1307 - Health Plan Sanctions

Current through Register Vol. 50, No. 6, June 20, 2024
A. If the
				  department determines the Health Plan or its subcontractors has participated in
				  provider steering, the department, at its sole discretion, may impose the
				  following sanctions.
1. The member(s) may be
				  dis-enrolled from the health plan at the earliest effective date
				  allowed.
2. Up to 100 percent of
				  the monthly capitation payment or care management fee for the month(s) the
				  member(s) was enrolled in the health plan may be recouped.
3. The health plan may be assessed a monetary
				  penalty of up to $5,000 per member.
4. The health plan may be required to submit
				  a letter to each member notifying he member of their imposed sanction and of
				  their right to choose another health plan.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part I - Administration › Subpart 1 - General Provisions › Chapter 15 - Provider Screening and Enrollment › Section I-1501 - General Provisions

Current through Register Vol. 50, No. 6, June 20, 2024
A. Pursuant
				  to the provisions of the Patient Protection and Affordable Care Act (PPACA),
				  Public Law
				  111-148 and 42 CFR Part 455, Subpart E, the
				  Medicaid Program adopts the following provider enrollment and screening
				  requirements. The Centers for Medicare and Medicaid Services (CMS) has
				  established guidelines for provider categorization based on an assessment of
				  potential for fraud, waste, and abuse for each provider type. The Medicaid
				  Program shall determine the risk level for providers and will adopt these
				  federal requirements in addition to any existing requirements. Additional
				  enrollment requirements may be adopted in the future.
B. In accordance with PPACA and federal
				  regulations, the Medicaid program shall screen all initial applications,
				  including applications for a new practice location, and any applications
				  received in response to a re-enrollment or revalidation, utilizing the
				  following guidelines.
1. Provider types shall
				  be categorized by the following risk levels:
a. high categorical risk - categories of
				  service that pose a significant risk of fraud, waste, and abuse to the Medicaid
				  program;
b. moderate categorical
				  risk - categories of service that pose a moderate risk of fraud, waste, and
				  abuse to the Medicaid program;
c.
				  limited categorical risk - categories of service that pose a minor risk of
				  fraud, waste, and abuse to the Medicaid program.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part I - Administration › Subpart 1 - General Provisions › Chapter 15 - Provider Screening and Enrollment › Section I-1503 - Temporary Moratoria

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				  secretary of the U.S. Department of Health and Human Services (HSS) will
				  consult with the Department of Health and Hospitals (DHH) regarding the
				  imposition of temporary moratoria on enrollment of new providers or provider
				  types prior to imposition of the moratoria.
1. DHH shall impose temporary moratoria on
				  enrollment of new providers or provider types identified by the HHS secretary
				  as posing an increased risk to the Medicaid program.
2. DHH shall not be required to impose such a
				  moratorium if it is determined that imposition of a temporary moratorium would
				  adversely affect recipient's access to medical assistance.
a. If making such a determination, DHH must
				  notify the HHS secretary in writing.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part I - Administration › Subpart 3 - Managed Care for Physical and Behavioral Health › Chapter 21 - Dental Benefits Prepaid Ambulatory Health Plan › Section I-2101 - General Provisions

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Effective May 1, 2014, the Department of Health, Bureau of Health Services
				  Financing shall adopt provisions to establish a comprehensive system of
				  delivery for dental services covered under the Medicaid Program. The dental
				  benefits plan shall be administered under the authority of a 1915(b) waiver by
				  implementing a prepaid ambulatory health plan (PAHP) which shall be responsible
				  for the necessary operational and administrative functions to ensure adequate
				  service coordination and delivery.
B. All Medicaid beneficiaries will receive
				  dental services administered by a dental benefit plan manager (DBPM).
1. The number of DBPMs shall be no more than
				  required to meet the Medicaid enrollee capacity requirements and ensure choice
				  for Medicaid beneficiaries.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part I - Administration › Subpart 3 - Managed Care for Physical and Behavioral Health › Chapter 21 - Dental Benefits Prepaid Ambulatory Health Plan › Section I-2103 - Participation Requirements

Current through Register Vol. 50, No. 6, June 20, 2024
A. In order
				  to participate in the Medicaid Program, a DBPM must be a successful bidder, be
				  awarded a contract with the department, and complete the readiness
				  review.
B. A DBPM must:
1. meet the federal definition of a PAHP as
				  defined in 42 CFR §438 . 2;
2. have
				  a license or certificate of authority issued by the Louisiana Department of
				  Insurance to operate as a Medicaid risk bearing "prepaid entity" pursuant to
				  R.S.
				  22:1016 and submit with the proposal
				  response;
3. have a certificate
				  from the Louisiana Secretary of State, to conduct business in the
				  state;
4. meet solvency standards
				  as specified in federal regulations and title 22 of the
Louisiana
				  Revised Statutes
;
5. have
				  a network capacity to enroll a minimum of 1,288,625 Medicaid members into the
				  network;
6. be without an actual or
				  perceived conflict of interest that would interfere or give the appearance of
				  impropriety or of interfering with the contractual duties and obligations under
				  this contract or any other contract with LDH, and any and all applicable LDH
				  written policies. Conflict of interest shall include, but is not limited to,
				  the contractor serving, as the Medicaid fiscal intermediary contractor for
				  LDH;
7. be awarded a contract with
				  LDH, and successfully completed the readiness review prior to the start date of
				  operations; and
8. have the
				  ability to provide core dental benefits and services to all assigned members on
				  the day the Dental Benefits Program is implemented.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part I - Administration › Subpart 3 - Managed Care for Physical and Behavioral Health › Chapter 21 - Dental Benefits Prepaid Ambulatory Health Plan › Section I-2105 - Prepaid Ambulatory Health Plan Responsibilities

Current through Register Vol. 50, No. 6, June 20, 2024
A. The DBPM shall be responsible for the
				  administration and management of its requirements and responsibilities under
				  the contract with the department and any and all department issued guidance.
				  This includes all subcontracts, employees, agents and anyone acting for or on
				  behalf of the DBPM.
1. No subcontract or
				  delegation of responsibility shall terminate the legal obligation of the DBPM
				  to the department to ensure that all requirements are carried out.
2. A DBPM shall possess the expertise and
				  resources to ensure the delivery of dental benefits and services to members and
				  to assist in the coordination of covered dental services, as specified in the
				  terms of the contract.
3. A DBPM
				  shall have written policies and procedures governing its operation as specified
				  in the contract and department issued guidance.
4. A DBPM shall not discriminate against
				  enrollees on the basis of race, gender, color, national origin, age, health
				  status or need for dental services, and shall not use any policy or practice
				  that has the effect of discriminating on any such basis.
5. The DBPM shall abide by all enrollment and
				  disenrollment policy and procedures as outlined in the contract developed by
				  the department.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part I - Administration › Subpart 3 - Managed Care for Physical and Behavioral Health › Chapter 21 - Dental Benefits Prepaid Ambulatory Health Plan › Section I-2107 - Network Access Standards and Guidelines

Current through Register Vol. 50, No. 6, June 20, 2024
A. The DBPM must maintain and monitor a
				  provider network that is supported by written agreements and is sufficient to
				  provide adequate access to enrollees as required by federal law and the terms
				  as set forth in the contract. The DBPM shall adhere to the federal regulations
				  governing access standards, as well as the specific requirements of the
				  contract and all department-issued guides.
B. The DBPM shall cover all necessary
				  services to treat an emergency dental condition.
1.
Emergency Dental
				  Condition
-
a dental or oral condition that requires
				  immediate services for relief of symptoms and stabilization of the condition.
				  Such conditions include:
a. severe
				  pain;
b. hemorrhage;
c. acute infection;
d. traumatic injury to the teeth and
				  surrounding tissue; or
e. unusual
				  swelling of the face or gums.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part I - Administration › Subpart 3 - Managed Care for Physical and Behavioral Health › Chapter 21 - Dental Benefits Prepaid Ambulatory Health Plan › Section I-2109 - Benefits and Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. Core
				  benefits and services shall be furnished in an amount, duration, and scope that
				  is no less than the amount, duration, and scope for the same services furnished
				  to enrollees under the Louisiana Medicaid state plan.
1.
Core benefits and
				  services
shall be defined as those oral health care services and
				  benefits required to be provided to Medicaid eligible individuals as specified
				  under the terms of the contract and department-issued guides.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part I - Administration › Subpart 3 - Managed Care for Physical and Behavioral Health › Chapter 21 - Dental Benefits Prepaid Ambulatory Health Plan › Section I-2111 - Payment Methodology

Current through Register Vol. 50, No. 6, June 20, 2024
A. Payments
				  to the Dental Benefit Plan. The department, or its fiscal intermediary, shall
				  make monthly capitation payments to the dental benefit plan based on a per
				  member, per month (PMPM) rate.
1. The
				  department reserves the right to re-negotiate the PMPM rates:
a. if the rate floor is removed;
b. as a result of federal or state budget
				  reductions or increases;
c. due to
				  the inclusion or removal of a Medicaid covered dental service(s) not
				  incorporated into the monthly capitation rates; or
d. in order to comply with federal
				  requirements.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part I - Administration › Subpart 3 - Managed Care for Physical and Behavioral Health › Chapter 21 - Dental Benefits Prepaid Ambulatory Health Plan › Section I-2113 - Prompt Payment of Claims

Current through Register Vol. 50, No. 6, June 20, 2024
A. Network
				  Providers. All subcontracts executed by the DBPM shall comply with the terms in
				  the contract. Requirements shall include at a minimum:
1. the name and address of the official payee
				  to whom payment shall be made;
2.
				  the full disclosure of the method and amount of compensation or other
				  consideration to be received from the DBPM; and
3. the standards for the receipt and
				  processing of claims as specified by the department in the DBPM's contract with
				  the department and department-issued guides.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part I - Administration › Subpart 3 - Managed Care for Physical and Behavioral Health › Chapter 21 - Dental Benefits Prepaid Ambulatory Health Plan › Section I-2115 - Grievance and Appeals Processes

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  The DBPM shall adhere to the provisions governing the grievance and appeals
				  processes for coordinated care network prepaid models outlined in LAC
				  50:I.Chapter 37, Subparts B and C.
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 I - Administration › Subpart 3 - Managed Care for Physical and Behavioral Health › Chapter 21 - Dental Benefits Prepaid Ambulatory Health Plan › Section I-2117 - Independent Review Process for Dental Provider Claims

Current through Register Vol. 50, No. 6, June 20, 2024
A. Right of Dentist Providers to Independent
				  Review of Claims
1. Pursuant to Act 284 of
				  the 2018 Regular Session of the Louisiana Legislature, for adverse
				  determinations related to dental claims filed on or after November 20, 2018, a
				  dentist/dental provider shall have a right to an independent review of the
				  adverse action of the DBPM.
2. For
				  purposes of these provisions, adverse determinations shall refer to dental
				  claims submitted by healthcare providers for payment for dental services
				  rendered to Medicaid enrollees and denied by the DBPM, in whole or in part, or
				  more than 60 days have elapsed since the claim was submitted and the dentist
				  has received no remittance advice or other written or electronic notice from
				  the DBPM either partially or totally denying the claim.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part I - Administration › Subpart 3 - Managed Care for Physical and Behavioral Health › Chapter 31 - General Provisions › Section I-3101 - Introduction

Current through Register Vol. 50, No. 6, June 20, 2024
A. It is the
				  departments goal to operate a managed health care delivery system that:
1. improves access to care and care
				  coordination;
2. improves the
				  quality of services;
3. promotes
				  healthier outcomes for Medicaid recipients through the establishment of a
				  medical home system of care;
4.
				  provides budget stability; and
5.
				  results in savings as compared to an unmanaged fee-for-service
				  system.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part I - Administration › Subpart 3 - Managed Care for Physical and Behavioral Health › Chapter 31 - General Provisions › Section I-3103 - Recipient Participation

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				  following Medicaid recipients shall be mandatory participants in managed care:
1. mandatory enrollees:
a. children up to 19 years of age who are
				  eligible under §1902 and §1931 of the Social Security Act (hereafter referred
				  to as the Act) as poverty-level related groups and optional groups of older
				  children;
b. parents and caretaker
				  relatives who are eligible under §1902 and §1931 of the Act;
c. Childrens Health Insurance Program (CHIP)
				  (title XXI) children enrolled in Medicaid expansion program (LaCHIP Phase I,
				  II, III);
d. CHIP (title XXI)
				  prenatal care option (LaCHIP Phase IV) and children enrolled in the separate,
				  stand -alone CHIP program (LaCHIP Phase V);
e. pregnant women whose basis for eligibility
				  is pregnancy, who are only eligible for pregnancy-related services, and whose
				  eligibility extends until 60 days after the pregnancy ends;
f. non-dually eligible aged, blind, and
				  disabled adults over the age of 19;
g. uninsured women under the age of 65 who
				  have been screened through the Centers for Disease Control National Breast and
				  Cervical Cancer Early Detection Program and identified as being in need of
				  treatment for breast and/or cervical cancer, including pre-cancerous conditions
				  and early stage cancer, and are not otherwise eligible for Medicaid;
h. individuals eligible through the
				  Tuberculosis Infected Individual Program;
i. former foster care children eligible under
				  §1902(a)(10)(A)(i)(IX) and (XVII) of the Act;
j. individuals and families who have more
				  income than is allowed for Medicaid eligibility, but who meet the standards for
				  the Regular Medically Needy Program;
k. individuals from age 19 to 65 years old at
				  or below 133 percent of the federal poverty level with a 5 percent income
				  disregard as provided in
				  42
				  CFR 435.119, hereafter referred to as the new
				  adult group; or
l. individuals
				  eligible through the Act 421 Children's Medicaid Option (421-CMO)
				  program.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part I - Administration › Subpart 3 - Managed Care for Physical and Behavioral Health › Chapter 31 - General Provisions › Section I-3105 - Enrollment Process

Current through Register Vol. 50, No. 6, June 20, 2024
A. The MCO
				  shall abide by all enrollment and disenrollment policy and procedures as
				  outlined in the contract developed by the department.
B. The department will contract with an
				  enrollment broker who will be responsible for the enrollment and disenrollment
				  process for MCO participants. The enrollment broker shall be:
1. the primary contact for Medicaid
				  recipients regarding the MCO enrollment and disenrollment process, and shall
				  assist the recipient to enroll in an MCO;
2. the only authorized entity, other than the
				  department, to assist a Medicaid recipient in the selection of an MCO;
				  and
3. responsible for notifying
				  all MCO members of their enrollment and disenrollment rights and
				  responsibilities within the timeframe specified in the contract.