reglab/statecodes huggingface dataset:
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XV - Services for Special Populations › Subpart 5 - Early and Periodic Screenings, Diagnosis, and Treatments › Chapter 95 - School-Based Health Services › Subchapter C - School-Based Medicaid Personal Care Services › Section XV-9523 - Covered Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
					 following school-based personal care services shall be covered:
1. basic personal care, toileting, diapering,
					 and grooming activities;
2.
					 assistance with bladder and/or bowel requirements or problems, including
					 helping the child to and from the bathroom, but excluding
					 catheterization;
3. assistance with
					 eating and food, nutrition, and diet activities;
4. accompanying, but not transporting, the
					 beneficiary to and from his/her physician and/or medical facility for necessary
					 medical services;
5. provides
					 assistance with transfers, positioning and repositioning; and
6. provide positive behavior support
					 strategies to assist students with prompting to perform services related to
					 physical and/or behavioral health needs.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XV - Services for Special Populations › Subpart 5 - Early and Periodic Screenings, Diagnosis, and Treatments › Chapter 95 - School-Based Health Services › Subchapter C - School-Based Medicaid Personal Care Services › Section XV-9525 - Reimbursement Methodology

Current through Register Vol. 50, No. 6, June 20, 2024
A. Cost
					 reporting will be handled in accordance with
					 §9505 A
1. - 4. Repealed.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XV - Services for Special Populations › Subpart 5 - Early and Periodic Screenings, Diagnosis, and Treatments › Chapter 95 - School-Based Health Services › Subchapter D - School-Based Therapy Services (Repealed) › Section XV-9531 - General Provisions (Repealed)

Current through Register Vol. 50, No. 6, June 20, 2024
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 XV - Services for Special Populations › Subpart 5 - Early and Periodic Screenings, Diagnosis, and Treatments › Chapter 95 - School-Based Health Services › Subchapter D - School-Based Therapy Services (Repealed) › Section XV-9533 - Covered Services (Repealed)

Current through Register Vol. 50, No. 6, June 20, 2024
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 XV - Services for Special Populations › Subpart 5 - Early and Periodic Screenings, Diagnosis, and Treatments › Chapter 95 - School-Based Health Services › Subchapter D - School-Based Therapy Services (Repealed) › Section XV-9535 - Reimbursement Methodology (Repealed)

Current through Register Vol. 50, No. 6, June 20, 2024
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 XV - Services for Special Populations › Subpart 5 - Early and Periodic Screenings, Diagnosis, and Treatments › Chapter 95 - School-Based Health Services › Subchapter E - School-Based Applied Behavior Analysis-Based Services (Repealed) › Section XV-9541 - General Provisions (Repealed)

Current through Register Vol. 50, No. 6, June 20, 2024
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 XV - Services for Special Populations › Subpart 5 - Early and Periodic Screenings, Diagnosis, and Treatments › Chapter 97 - Office of Public Health Uncompensated Care Payments › Section XV-9701 - General Provisions

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Effective for dates of service on or after July 1, 2012, the department shall
				  provide the Office of Public Health (OPH) with Medicaid payment of their
				  uncompensated care costs for child health services including hearing and speech
				  therapy services, maternity services, and children's special health services
				  rendered to Medicaid recipients.
B.
				  The Office of Public Health shall certify public expenditures to the Medicaid
				  Program in order to secure federal funding for services provided at the cost of
				  OPH.
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 XV - Services for Special Populations › Subpart 5 - Early and Periodic Screenings, Diagnosis, and Treatments › Chapter 97 - Office of Public Health Uncompensated Care Payments › Section XV-9703 - Reimbursement Methodology

Current through Register Vol. 50, No. 6, June 20, 2024
A. The OPH
				  will submit an estimate of cost for services provided under this Chapter. The
				  estimated cost will be calculated based on the previous fiscal year's
				  expenditures and reduced by the estimate of payments made for services to OPH
				  under this Chapter, which will be referred to as the net uncompensated care
				  cost. The uncompensated care cost will be reported on a quarterly
				  basis
B. Upon completion of the
				  fiscal year, the Office of Public Health will submit a cost report which will
				  be used as a settlement of cost within one year of the end of the fiscal year.
1. Any adjustments to the net uncompensated
				  care cost for a fiscal year will be reported on the CMS Form 64 as a prior
				  period adjustment in the quarter of settlement.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XV - Services for Special Populations › Subpart 7 - Targeted Case Management › Chapter 101 - General Provisions › Section XV-10101 - Program Description

Current through Register Vol. 50, No. 6, June 20, 2024
A. This
				  Subpart 7 governs the provision of case management services to targeted
				  population groups and certain home and community based services waiver groups.
				  The primary objective of case management is the attainment of the personal
				  outcomes identified in the recipient's comprehensive plan of care. All case
				  management agencies shall be required to incorporate personal outcome measures
				  in the development of comprehensive plans of care and to implement procedures
				  for self-evaluation of the agency. All case management agencies shall comply
				  with the policies contained in this Subpart 7. Case management is defined as
				  services provided to individuals to assist them in gaining access to the full
				  range of needed services including:
1.
				  medical;
2. social;
3. educational; and
4. other support services.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XV - Services for Special Populations › Subpart 7 - Targeted Case Management › Chapter 105 - Provider Participation › Section XV-10501 - Participation Requirements

Current through Register Vol. 50, No. 6, June 20, 2024
A. In order
				  to participate as a case management services provider in the Medicaid Program,
				  an agency shall comply with:
1. licensure and
				  certification requirements;
2.
				  provider enrollment;
3. the Case
				  Management Manual; and
4. the
				  specific terms of individual performance agreements.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XV - Services for Special Populations › Subpart 7 - Targeted Case Management › Chapter 105 - Provider Participation › Section XV-10503 - Provider Responsibilities

Current through Register Vol. 50, No. 6, June 20, 2024
A. In
				  order to be reimbursed by the Medicaid Program, an enrolled provider of
				  targeted or waiver case management service shall comply with all of the
				  requirements listed in this §10503
B. Case management agencies shall maintain
				  sufficient staff to serve recipients within the mandated caseload size of 35
				  with a supervisor to staff ratio of no more than eight case managers per
				  supervisor. Agencies have the option to submit a written request to OCDD if
				  they would like to exceed the 35 recipient maximum caseload per case manager on
				  a time-limited basis. All exceptions to the maximum caseload size or full-time
				  employment of staff requirements shall be prior authorized by the OCDD State
				  Office Waiver Director/designee. All case managers shall be employed by the
				  agency at least 40 hours per five business days and work at least 50 percent of
				  the time during normal business hours. Case management supervisors shall be
				  full-time employees and shall be continuously available to case managers. The
				  agency shall have a written policy to ensure service coverage for all
				  recipients during the normal absences of case managers and supervisors or prior
				  to the filling of vacated staff positions.
C. The agency shall maintain a toll-free
				  telephone number to ensure that recipients have access to case management
				  services 24 hours a day, seven days a week. Recipients shall be able to reach
				  an actual person in case of an emergency via answering service and not a
				  recording.
D. ...
1. Each case management agency shall have a
				  written job description and consultation plan that describes how the nurse
				  consultant shall participate in the comprehensive plan of care (CPOC)
				  development for medically complex individuals and others as indicated by the
				  high-risk indicators.
2.The nurse
				  consultant shall provide consultation to the case management agency staff on
				  health-related issues as well as education and training for case managers and
				  case manager supervisors
3. The
				  nurse consultant shall be available to the case management agency at least four
				  hours per week, whether on-site or remotely.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XV - Services for Special Populations › Subpart 7 - Targeted Case Management › Chapter 105 - Provider Participation › Section XV-10505 - Staff Education and Experience

Current through Register Vol. 50, No. 6, June 20, 2024
A. Each Medicaid-enrolled agency shall ensure
				  that all staff providing case management services meet the qualifications
				  required in this
				  §10701 prior to assuming any full
				  caseload responsibilities.
B. Case
				  managers hired or promoted on or after the effective date of this rule revision
				  shall meet the following criteria for education and experience qualifications:
1. a bachelor's degree or master's degree in
				  social work from a program accredited by the Council on Social Work Education;
				  or
2. a currently licensed
				  registered nurse (RN); or
3. a
				  bachelor's or master's degree in a human service related field which includes
				  psychology education, counseling, social services, sociology, philosophy,
				  family and consumer sciences, criminal justice, rehabilitation services, child
				  development, substance abuse, gerontology, and vocational rehabilitation; or
4. a bachelor's degree in liberal
				  arts or general studies with a concentration of at least 16 hours in one of the
				  fields listed in accordance with
				  §10505.B 3;
				  or
5. a bachelor's or master's
				  degree in a field other than listed above, if approved by OCDD and the Bureau
				  of Health Services Financing (BHSF).
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XV - Services for Special Populations › Subpart 7 - Targeted Case Management › Chapter 105 - Provider Participation › Section XV-10507 - Staff Training

Current through Register Vol. 50, No. 6, June 20, 2024
A. Training for
				  case managers and supervisors shall be provided or arranged for by the case
				  management agency. Agencies shall send the appropriate staff to all training
				  mandated by LDH.
B. Training for
				  New Staff. A minimum of 16 hours of orientation shall be provided to all staff,
				  volunteers, and students within one week of employment. A minimum of eight
				  hours of the orientation training shall address the target population
				  including, but not limited to, specific service needs, available resources and
				  other topics. In addition to the required 16 hours of orientation, all new
				  employees who have no documentation of previous training shall receive a
				  minimum of 16 hours of training during the first 90 calendar days of employment
				  related to the target population and the skills and techniques needed to
				  provide case management to that population.
C. Annual Training. Case managers and
				  supervisors shall satisfactorily complete a minimum of 20 hours of case
				  management-related training annually which may include updates on subjects
				  covered in orientation and initial training. The 16 hours of orientation
				  training required for new employees are not included in the annual training
				  requirement of at least 20 hours.
D. Documentation. All training required in
				  Subsections B and C above shall be evidenced by written documentation and
				  provided to the department upon request.
E. Supervisory Responsibilities. Each case
				  management supervisor shall be responsible for assessing staff performance,
				  reviewing individual cases, providing feedback, and assisting staff to develop
				  problem solving skills using two or more of the following methods:
1. individual, face-to-face sessions with
				  staff;
2. group face-to-face
				  sessions with all case management staff; or
3. sessions in which the supervisor
				  accompanies a case manager to meet with recipients.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XV - Services for Special Populations › Subpart 7 - Targeted Case Management › Chapter 107 - Reimbursement › Section XV-10701 - Reimbursement

Current through Register Vol. 50, No. 6, June 20, 2024
A.Reimbursement for
				  case management services for the Infant and Toddler Program (EarlySteps):
1. Effective for dates of service on or after
				  July 1, 2022, case management services provided to participants in the
				  EarlySteps Program shall be reimbursed at a flat rate for each approved unit of
				  service.
a. The standard unit of service is
				  equivalent to one month and covers both service provision and administrative
				  (overhead) costs.
b. Service
				  provision includes the core elements in:
i.Section 10301 of this Subpart;
ii. the case management manual; and
iii. EarlySteps practices.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XV - Services for Special Populations › Subpart 7 - Targeted Case Management › Chapter 107 - Reimbursement › Section XV-10703 - Cost Reports

Current through Register Vol. 50, No. 6, June 20, 2024
A. Case
				  management agencies shall provide annual cost reports based on the state fiscal
				  year, July 1 through June 30. Completed reports are due within 90 calendar days
				  after the end of each state fiscal year or by September 28 of each calendar
				  year.
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 XV - Services for Special Populations › Subpart 7 - Targeted Case Management › Chapter 107 - Reimbursement › Section XV-10704 - Targeted Case Management Workforce Retention Bonus Payments

Current through Register Vol. 50, No. 6, June 20, 2024
A. Establishment of Targeted Case Management
				  Workforce Retention Bonus Payments
1. Case
				  management agencies for the early and periodic screening, diagnosis, and
				  treatment (EPSDT) targeted population and for participants in the New
				  Opportunities Waiver (NOW) who provided services from April 1, 2021 to October
				  31, 2022 shall receive bonus payments of $300 per month for the case manager
				  that worked with participants for those months.
2. The case manager who provided services to
				  participants from April 1, 2021 to October 31, 2022 must receive at least $250
				  of this $300 bonus payment paid to the agency. This bonus payment is effective
				  for all affected case managers of any working status, whether full-time or
				  part-time.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XV - Services for Special Populations › Subpart 7 - Targeted Case Management › Chapter 109 - Infants and Toddlers › Section XV-10901 - Introduction

Current through Register Vol. 50, No. 6, June 20, 2024
A. This Chapter
				  authorizes federal financial participation in the funding of optional targeted
				  case management service for title XIX eligible infants and toddlers who are
				  ages birth through 2 inclusive (0-35 months) who have a developmental delay or
				  established medical condition associated with developmental delay according to
				  the definition contained in part C of the Individuals with Disabilities
				  Education Act, Sec.635(a)(1) [20 USC 1435
				  (a)(1)] and as further defined in Title 34 of
				  the Code of Federal Regulations, Part 303, Section 21 (infant or toddler with a
				  disability).
B. Purpose. To assist
				  eligible recipients in development skills and knowledge to enable them to
				  effectively access and utilize:
1. medical
				  care;
2. social services;
3. educational services; and
4. other service delivery systems.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XV - Services for Special Populations › Subpart 7 - Targeted Case Management › Chapter 109 - Infants and Toddlers › Section XV-10903 - Staff Qualifications (Repealed)

Current through Register Vol. 50, No. 6, June 20, 2024
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 XV - Services for Special Populations › Subpart 7 - Targeted Case Management › Chapter 109 - Infants and Toddlers › Section XV-10905 - Staff Training

Current through Register Vol. 50, No. 6, June 20, 2024
A. The provider
				  shall ensure that Medicaid-funded family service coordination services for
				  eligible beneficiaries are provided by qualified individuals who meet the
				  following training requirements:
1.
				  satisfactory completion of at least 16 hours of orientation prior to performing
				  any family support coordination tasks and an additional 24 hours of related
				  training during the first 90 days of employment. The 16 hours of orientation
				  cover the following subjects:
Agency Specific Training-Eight
								Hours
1 hour
Child identification abuse reporting law, emergency
								and safety procedures
3 hours
Facility personnel policy
4 hours
Orientation to agency policy, including billing and
								documentation
EarlySteps Specific
								Training-Eight Hours
1 hour
Components of the EarlySteps system
1 1/2 hours
Orientation to family needs and
								participation
2 hours
Interagency agreement/focus and team
								building
1 hour
Early intervention services (definition and
								resources)
1 hour
Child search and family service coordinator roles
								and responsibilities
1 1/2 hours
Multidisciplinary evaluation (MDE) and
								individualized Family service plan (IFSP) overview.
2.
				  The 24 hours of training to be completed within the first 90 days shall cover
				  the following advanced subjects:
a. state
				  structure for EarlySteps, child search and early intervention service
				  programs;
b. child search and
				  family support coordinator roles and responsibilities in depth;
c. multidisciplinary evaluation (MDE) in
				  depth;
d. procedural safeguards and
				  complaint procedures;
e. family
				  perspective, including the grieving process;
f. cultural diversity;
g. communication with parents and
				  professionals;
h. family
				  empowerment and advocacy;
i.
				  resources, including adaptation of resources to the child's needs;
				  and
j. arranging access for
				  families to support systems, including informal systems.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XV - Services for Special Populations › Subpart 7 - Targeted Case Management › Chapter 113 - Early and Periodic Screening, Diagnosis and Treatment › Section XV-11301 - Introduction

Current through Register Vol. 50, No. 6, June 20, 2024
A. This Early and
				  Periodic Screening, Diagnosis and Treatment (EPSDT) targeted population shall
				  consist of recipients who are between the ages of 0 and 21 years old, on the
				  Request for Services Registry, and meet the specified eligibility criteria. The
				  point of entry for targeted EPSDT case management services shall be the state
				  Medicaid data contractor for EPSDT case management services. However, for those
				  recipients under 3 years of age, case management services shall continue to be
				  provided through EarlySteps, for eligible children.
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 XV - Services for Special Populations › Subpart 7 - Targeted Case Management › Chapter 113 - Early and Periodic Screening, Diagnosis and Treatment › Section XV-11303 - Recipient Qualifications

Current through Register Vol. 50, No. 6, June 20, 2024
A. In
				  order to be eligible to receive case management services, the EPSDT recipient
				  shall be between the age of 0 and 21 and meet one of the following criteria:
1. placement on the Request for Services
				  Registry and determined to be eligible for OCDD services through the statement
				  of approval process; or
2. for
				  those who do not meet eligibility, or who are not undergoing eligibility
				  determination, may still receive case management services if they meet the
				  definition of a person with special needs.
a.
Special Needs
-a documented, established medical condition, as
				  determined by a licensed physician or other qualified licensed health care
				  practitioner in accordance with
				  §10501.C 10, that has a
				  high probability of resulting in a developmental delay or that gives rise to a
				  need for multiple medical, social, educational, and other services. In the case
				  of a hearing impairment, the determination of special needs must be made by a
				  licensed audiologist or physician or other qualified licensed health care
				  practitioner in accordance with
				  §10501.C 10.
3. Documentation that
				  substantiates that the EPSDT recipient meets the definition of special needs
				  for case management services includes, but is not limited to:
a. receipt of special education services
				  through the state or local education agency; or
b. receipt of regular services from one or
				  more physicians or other qualified licensed health care practitioner in
				  accordance with
				  §10501.C 10;
				  or
c. receipt of or application for
				  financial assistance such as SSI because of a medical condition, or the
				  unemployment of the parent due to the need to provide specialized care for the
				  child; or
d. a report by the
				  recipient's physician or other qualified licensed health care practitioner in
				  accordance with
				  §10501.C 10 of multiple
				  health or family issues that impact the recipient's ongoing care; or
e. a determination of developmental delay
				  based upon:
i. the Parents' Evaluation of
				  Pediatric Status;
ii. the Brigance
				  Screens;
iii. the Child Development
				  Inventories;
iv. an appropriate
				  screening tool; or
v. any other
				  nationally-recognized diagnostic tool.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XV - Services for Special Populations › Subpart 7 - Targeted Case Management › Chapter 115 - Foster Care and Family Support Worker Services › Section XV-11501 - Introduction (Repealed)

Current through Register Vol. 50, No. 6, June 20, 2024
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 XV - Services for Special Populations › Subpart 7 - Targeted Case Management › Chapter 115 - Foster Care and Family Support Worker Services › Section XV-11503 - Covered Services (Repealed)

Current through Register Vol. 50, No. 6, June 20, 2024
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 XV - Services for Special Populations › Subpart 7 - Targeted Case Management › Chapter 115 - Foster Care and Family Support Worker Services › Section XV-11505 - Reimbursement (Repealed)

Current through Register Vol. 50, No. 6, June 20, 2024
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 XV - Services for Special Populations › Subpart 7 - Targeted Case Management › Chapter 117 - Individuals with Developmental Disabilities › Section XV-11701 - Introduction

Current through Register Vol. 50, No. 6, June 20, 2024
A. The targeted
				  population for case management services shall consist of individuals with
				  intellectual disabilities who are participants in the New Opportunities
				  Waiver.
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 XV - Services for Special Populations › Subpart 7 - Targeted Case Management › Chapter 117 - Individuals with Developmental Disabilities › Section XV-11703 - Electronic Visit Verification

Current through Register Vol. 50, No. 6, June 20, 2024
A. An
				  electronic visit verification (EVV) system shall be used for verifying in-home
				  or face-to-face visit requirements for case management services.
1. Case management providers identified by
				  the department shall use the (EVV) system designated by the
				  department;
2. Reimbursement for
				  services may be withheld or denied if a provider:
a. fails to use the EVV system; or
b. uses the system in a manner that is not in
				  compliance with Medicaid's policies and procedures for EVV.
3. Requirements for proper use of
				  the EVV system are outlined in the respective program's guidelines.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XV - Services for Special Populations › Subpart 9 - Personal Care Services › Chapter 129 - Long Term Care › Section XV-12901 - General Provisions

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				  purpose of long term-personal care services (LT-PCS) is to assist individuals
				  with functional impairments with their daily living activities. LT-PCS must be
				  provided in accordance with an approved service plan and supporting
				  documentation. In addition, LT-PCS must be coordinated with the other Medicaid
				  and non-Medicaid services being provided to the participant and will be
				  considered in conjunction with those other services.
B. Each individual requesting or receiving
				  long term-personal care services (LT-PCS) shall undergo a functional
				  eligibility screening utilizing an eligibility screening tool called the level
				  of care eligibility tool (LOCET), or a subsequent eligibility tool designated
				  by the Office of Aging and Adult Services (OAAS).
C. Each LT-PCS applicant/participant shall be
				  assessed using a uniform inter RAI home care assessment tool or a subsequent
				  assessment tool designated by OAAS. The assessment is designed to verify that
				  an individual meets eligibility qualifications and to determine resource
				  allocation while identifying an individual's need for support in performance of
				  activities of daily living (ADLs). The assessment generates a score which
				  measures the individual's degree of self-performance of the following
				  activities of daily living:
1. bed
				  mobility;
2. toilet
				  transfer;
3. toilet use;
				  and
4. eating.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XV - Services for Special Populations › Subpart 9 - Personal Care Services › Chapter 129 - Long Term Care › Section XV-12902 - Participant Direction Option (Repealed)

Current through Register Vol. 50, No. 6, June 20, 2024
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 XV - Services for Special Populations › Subpart 9 - Personal Care Services › Chapter 129 - Long Term Care › Section XV-12903 - Covered Services

Current through Register Vol. 50, No. 6, June 20, 2024
A.
LT-PCS
are defined as those services that provide assistance
				  with the distinct tasks associated with the performance of the activities of
				  daily living (ADLs) and the instrumental activities of daily living (IADLs).
				  Assistance may be either the actual performance of the personal care task for
				  the individual or supervision and prompting so the individual performs the task
				  by themselves.
1. ADLs are those personal,
				  functional activities required by the participant. ADLs include tasks such as:
a. eating;
b. bathing;
c. dressing;
d. grooming/personal hygiene;
e. transferring;
f. ambulation;
g. toileting; and
h. bed mobility.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XV - Services for Special Populations › Subpart 9 - Personal Care Services › Chapter 129 - Long Term Care › Section XV-12905 - Eligibility Criteria

Current through Register Vol. 50, No. 6, June 20, 2024
A. Personal
				  care services shall be available to recipients who are 65 years of age or
				  older, or 21 years of age or older and have a disability. Persons with a
				  disability must meet the disability criteria established by the Social Security
				  Administration.
B. Recipients must
				  meet the eligibility criteria established by OAAS or its designee. Personal
				  care services are medically necessary if the recipient:
1. meets the medical standards for admission
				  to a nursing facility and requires limited assistance with at least one or more
				  activities of daily living;
2. is
				  able, either independently or through a responsible representative, to
				  participate in his/her care and direct the services provided by the personal
				  care services worker. A responsible representative is defined as the person
				  designated by the recipient to act on his/her behalf in the process of
				  accessing and/or maintaining personal care services; and
3. faces a substantial possibility of
				  deterioration in mental or physical condition or functioning if either home and
				  community-based services or nursing facility services are not provided in less
				  than 120 days. This criterion is considered met if:
a. the recipient is in a nursing facility and
				  could be discharged if community-based services were available;
b. is likely to require nursing facility
				  admission within the next 120 days; or
c. has a primary caregiver who has a
				  disability or is over the age of 70.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XV - Services for Special Populations › Subpart 9 - Personal Care Services › Chapter 129 - Long Term Care › Section XV-12907 - Recipient Rights and Responsibilities

Current through Register Vol. 50, No. 6, June 20, 2024
A. Recipients who receive services under the
				  Long-Term Personal Care Services Program have the right to actively participate
				  in the development of their plan of care and the decision-making process
				  regarding service delivery. Recipients also have the right to freedom of choice
				  in the selection of a provider of personal care services and to participate in
				  the following activities:
1. interviewing and
				  selecting the personal care worker who will be providing services in their
				  home;
2. developing the work
				  schedule for their personal care worker;
3. training the individual personal care
				  worker in the specific skills necessary to maintain the recipient's independent
				  functioning while maintaining him/her in the home;
4. developing an emergency component in the
				  plan of care that includes a list of personal care staff who can serve as
				  back-up when unforeseen circumstances prevent the regularly scheduled worker
				  from providing services;
5. signing
				  off on payroll logs and other documentation to verify staff work hours and to
				  authorize payment;
6. evaluating
				  the personal care worker's job performance; and
7. changing the personal care worker assigned
				  to provide their services;
8. an
				  informal resolution process to address their complaints and/or concerns
				  regarding personal care services; and
9. a formal resolution process to address
				  those situations where the informal resolution process fails to resolve their
				  complaint.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XV - Services for Special Populations › Subpart 9 - Personal Care Services › Chapter 129 - Long Term Care › Section XV-12909 - Standards for Participation

Current through Register Vol. 50, No. 6, June 20, 2024
A. In order
				  to participate as a personal care services provider in the Medicaid Program, an
				  agency:
1. must comply with:
a. state licensing regulations;
b. Medicaid provider enrollment
				  requirements;
c. the standards of
				  care set forth by the Louisiana Board of Nursing; and
d. any federal or state laws, rules,
				  regulations, policies and procedures contained in the Medicaid provider manual
				  for personal care services, or other document issued by the department. Failure
				  to do may result in sanctions;
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XV - Services for Special Populations › Subpart 9 - Personal Care Services › Chapter 129 - Long Term Care › Section XV-12910 - La POP Standards for Participation (Repealed)

Current through Register Vol. 50, No. 6, June 20, 2024
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 XV - Services for Special Populations › Subpart 9 - Personal Care Services › Chapter 129 - Long Term Care › Section XV-12911 - Staffing Requirements

Current through Register Vol. 50, No. 6, June 20, 2024
A. All
				  staff providing direct care to the recipient must meet the qualifications for
				  furnishing personal care services per the licensing regulations. The direct
				  service worker shall demonstrate empathy toward the elderly and persons with
				  disabilities, an ability to provide care to these recipients, and the maturity
				  and ability to deal effectively with the demands of the job.
B. Restrictions
1. The following individuals are prohibited
				  from being reimbursed for providing services to a recipient:
a. the recipient's spouse;
b. the recipient's curator;
c. the recipient's tutor;
d. the recipient's legal guardian;
e. the recipient's designated responsible
				  representative; or
f. the person to
				  whom the recipient has given representative and mandate authority (also known
				  as Power of Attorney).
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XV - Services for Special Populations › Subpart 9 - Personal Care Services › Chapter 129 - Long Term Care › Section XV-12912 - Training (Repealed)

Current through Register Vol. 50, No. 6, June 20, 2024
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 XV - Services for Special Populations › Subpart 9 - Personal Care Services › Chapter 129 - Long Term Care › Section XV-12913 - Service Delivery

Current through Register Vol. 50, No. 6, June 20, 2024
A. Personal
				  care services shall be provided in the recipient's home or in another location
				  outside of the recipient's home if the provision of these services allows the
				  recipient to participate in normal life activities pertaining to the IADLs
				  cited in the plan of care. The recipient's home is defined as the place where
				  he/she resides such as a house, an apartment, a boarding house, or the house or
				  apartment of a family member or unpaid primary care-giver. IADLs cannot be
				  performed in the recipient's home when the recipient is absent from the home,
				  unless it is approved by OAAS or its designee on a case-by-case
				  basis.
B. The provision of services
				  outside of the recipients home does not include trips outside of the borders of
				  the state without approval of OAAS or its designee.
C. Participants are not permitted to live in
				  a home or property owned, operated, or controlled by an owner, operator, agent,
				  or employee of a licensed provider of longterm care services, and providers are
				  prohibited from providing and billing for services under these circumstances.
				  Participants may not live in the home of their direct support worker unless the
				  direct support worker is related to, and it is the choice of, the participant.
1. The provisions of
				  §12913. C may be waived
				  with prior written approval by OAAS or its designee.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XV - Services for Special Populations › Subpart 9 - Personal Care Services › Chapter 129 - Long Term Care › Section XV-12915 - Service Limitations

Current through Register Vol. 50, No. 6, June 20, 2024
A. Personal
				  care services shall be limited to up to 32 hours per week. Authorization of
				  service hours shall be considered on a case-by-case basis as substantiated by
				  the recipient's plan of care and supporting documentation.
B. There shall be no duplication of services.
1. Personal care services may not be provided
				  while the recipient is admitted to or attending a program which provides
				  in-home assistance with IADLs or ADLs or while the recipient is admitted to or
				  attending a program or setting where such assistance is available to the
				  recipient.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XV - Services for Special Populations › Subpart 9 - Personal Care Services › Chapter 129 - Long Term Care › Section XV-12917 - Reimbursement

Current through Register Vol. 50, No. 6, June 20, 2024
A. Reimbursement
				  for personal care services shall be a prospective flat rate for each approved
				  unit of service that is provided to the participant. One quarter hour (15
				  minutes) is the standard unit of service for personal care services.
				  Reimbursement shall not be paid for the provision of less than one quarter hour
				  (15 minutes) of service. Additional reimbursement shall not be available for
				  transportation furnished during the course of providing personal care
				  services.
B. The state has the
				  authority to set and change LT-PCS rates and/or provide lump sum payments to
				  LT-PCS providers based upon funds allocated by the legislature.
C. 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 XV - Services for Special Populations › Subpart 9 - Personal Care Services › Chapter 129 - Long Term Care › Section XV-12919 - Cost Reporting Requirements

Current through Register Vol. 50, No. 6, June 20, 2024
A. LT-PCS providers must complete annual cost
				  reports.
B. Each LT-PCS provider
				  shall complete the LDH approved cost report and submit the cost report(s) to
				  the department no later than five months after the state fiscal year ends (June
				  30).
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 XV - Services for Special Populations › Subpart 9 - Personal Care Services › Chapter 129 - Long Term Care › Section XV-12921 - Direct Service Worker Wages, Other Benefits, and Workforce Bonus Payments

Current through Register Vol. 50, No. 6, June 20, 2024
A. Establishment of
				  Direct Service Worker Wage Floor and Other Benefits
1. Long term-personal care services (LT-PCS)
				  providers that were providing LT-PCS on or after October 1, 2021 and employing
				  direct service workers (DSWs) will receive the equivalent of a $4.50 per hour
				  rate increase.
2. This increase or
				  its equivalent will be applied to all service units provided by DSWs with an
				  effective date of service for the LT-PCS provided on or after October 1,
				  2021.
3. All LT-PCS providers
				  affected by this rate increase shall be subject to passing 70 percent of their
				  rate increases directly to the DSW in various forms. These forms include a
				  minimum wage floor of $9 per hour and wage and non-wage benefits. This wage
				  floor and wage and non-wage benefits are effective for all affected DSWs of any
				  working status, whether full-time or part-time.
4. The LT-PCS provider rate increases, wage
				  floor and/or wage and non-wage benefits will end March 31, 2025 or when the
				  state's funding authorized under section 9817 of the American Rescue Plan Act
				  of 2021 (Pub. L. No. 117-002) is exhausted.
5. The Department of Health (LDH) reserves
				  the right to adjust the DSW wage floor and/or wage and non-wage benefits as
				  needed through appropriate rulemaking promulgation consistent with the
				  Administrative Procedure Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XV - Services for Special Populations › Subpart 11 - Personal Assistant Services › Chapter 141 - Employment Support › Section XV-14101 - General Provisions (Repealed)

Current through Register Vol. 50, No. 6, June 20, 2024
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 XV - Services for Special Populations › Subpart 11 - Personal Assistant Services › Chapter 141 - Employment Support › Section XV-14103 - Covered Services (Repealed)

Current through Register Vol. 50, No. 6, June 20, 2024
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 XV - Services for Special Populations › Subpart 11 - Personal Assistant Services › Chapter 141 - Employment Support › Section XV-14105 - Recipient Qualifications (Repealed)

Current through Register Vol. 50, No. 6, June 20, 2024
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 XV - Services for Special Populations › Subpart 11 - Personal Assistant Services › Chapter 141 - Employment Support › Section XV-14107 - Recipient Rights (Repealed)

Current through Register Vol. 50, No. 6, June 20, 2024
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 XV - Services for Special Populations › Subpart 11 - Personal Assistant Services › Chapter 141 - Employment Support › Section XV-14109 - Standards for Participation (Repealed)

Current through Register Vol. 50, No. 6, June 20, 2024
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 XV - Services for Special Populations › Subpart 11 - Personal Assistant Services › Chapter 141 - Employment Support › Section XV-14113 - Place of Service (Repealed)

Current through Register Vol. 50, No. 6, June 20, 2024
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 XV - Services for Special Populations › Subpart 11 - Personal Assistant Services › Chapter 141 - Employment Support › Section XV-14115 - Service Limitations (Repealed)

Current through Register Vol. 50, No. 6, June 20, 2024
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 XV - Services for Special Populations › Subpart 11 - Personal Assistant Services › Chapter 141 - Employment Support › Section XV-14117 - Reimbursement Methodology (Repealed)

Current through Register Vol. 50, No. 6, June 20, 2024
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 XV - Services for Special Populations › Subpart 13 - Pregnant Women Extended Services › Chapter 163 - Substance Use Screening and Intervention Services › Section XV-16301 - General Provisions

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				  department shall provide coverage of medically necessary substance use
				  screening and intervention services rendered to Medicaid-eligible pregnant
				  women at the discretion of the medical professional providing care to the
				  pregnant woman.
B.
				  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 XV - Services for Special Populations › Subpart 13 - Pregnant Women Extended Services › Chapter 163 - Substance Use Screening and Intervention Services › Section XV-16303 - Scope of Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. Screening
				  services shall include the screening of pregnant women for:
1. alcohol use;
2. tobacco use;
3. drug use; and/or
4. domestic violence.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XV - Services for Special Populations › Subpart 13 - Pregnant Women Extended Services › Chapter 163 - Substance Use Screening and Intervention Services › Section XV-16305 - Reimbursement Methodology

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Reimbursement for substance use screening and intervention services provided to
				  pregnant women shall be a flat fee based on the appropriate current procedural
				  terminology (CPT) code.
1.
				  Repealed.