reglab/statecodes huggingface dataset:
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 103 - Standards for Payment for Intermediate Care Facilities for the Mentally Retarded (ICF/MR) › Subchapter A - Foreword, Definitions and Acronyms › Section II-10301 - Foreword

Current through Register Vol. 50, No. 6, June 20, 2024
A. The ICF/MR
					 Standards for Payment specify the requirements of federal and state law and
					 regulations governing services provided by Intermediate Care Facilities for the
					 Mentally Retarded and persons with other Developmental Disabilities
					 (ICF/MR).
B. The Medicaid Program
					 is administered by the Louisiana Department of Health and Hospitals (DHH) in
					 cooperation with other federal and state agencies.
C. Standards are established to ensure
					 minimum compliance under the law, equity among those served, provision of
					 authorized services, and proper disbursement. If there is a conflict between
					 material in these standards and the federal and state laws or policies
					 governing the program, the state laws or policies governing the program have
					 precedence. These standards provide the ICF/MR with information necessary to
					 fulfill the provider enrollment contract with the agency. It is the ICF/MR
					 facility's responsibility to keep these standards current. The standards are
					 the basis for surveys by federal and state agencies, are part of the enrollment
					 contract, and are necessary for the ICF/MR to remain in compliance with federal
					 and state laws.
D. Monitoring of an
					 ICF/MR's compliance with state and federal regulations is the responsibility of
					 DHH's Bureau of Health Services Financing (BHFS).
E. The Bureau of Health Services Financing
					 (BHSF) Health Standards Section (HSS) is responsible for determining an
					 ICF/MR's compliance with state licensing requirements and compliance with
					 specific Title XIX certification requirements which include physical plant,
					 staffing, dietary, pharmaceuticals, active treatment, and other standards.
					 Minimum Licensure Requirements for ICF/MRs are covered in the booklet entitled
Licensing Requirements for Residential Care Providers
and
					 Subpart I of the
Code of Federal Regulations
, Chapter
					 42:483.400-483.480.
AUTHORITY NOTE:
						Promulgated in accordance with
						R.S.
						46:153.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 103 - Standards for Payment for Intermediate Care Facilities for the Mentally Retarded (ICF/MR) › Subchapter B - Participation › Section II-10305 - General Provisions

Current through Register Vol. 50, No. 6, June 20, 2024
NOTE: The federal regulation pertaining to this Section
						is 42 CFR 442 -
						483.400
						and
						435.1008.
A. Scope
1.
					 The standards set forth in this and subsequent sections comply with the Title
					 XIX requirements of the amended Social Security Act. That Act sets the
					 standards for the care, treatment, health, safety, welfare and comfort of
					 Medical Assistance clients in facilities providing ICF/MR services.
2. These standards apply to ICF/MRs certified
					 and enrolled by the Louisiana Department of Health and Hospitals (DHH) for
					 vendor participation.
3. These
					 standards supplement current licensing requirements applicable to ICF/MRs. Any
					 infraction of these standards may be considered a violation of the provider
					 agreement between DHH and the ICF/MR.
4. In the event any of these standards are
					 not maintained, DHH will determine whether facility certification will continue
					 with deficiencies as is allowed under Title XIX regulations or whether
					 termination of the Provider Agreement is warranted. Although vendor payment
					 will not be suspended during the determination period, deficiencies which may
					 affect the health, safety, rights and welfare of Medical Assistance clients
					 must be corrected expeditiously in order for the ICF/MR to continue to
					 participate.
5. If a certified
					 ICF/MR is found to have deficiencies which immediately jeopardize the health,
					 safety, rights and welfare of its Medical Assistance clients, DHH may initiate
					 proceedings to terminate the ICF/MR's certification. In the event of less
					 serious deficiencies, DHH may impose interim sanctions (see §10357,
					 Sanctions).
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 103 - Standards for Payment for Intermediate Care Facilities for the Mentally Retarded (ICF/MR) › Subchapter B - Participation › Section II-10307 - Payments

Current through Register Vol. 50, No. 6, June 20, 2024
NOTE: Regulations for this Section are found in the
						state's
Medicaid Eligibility Manual
, Chapter XIX (19).
A. Income Consideration in Determining
					 Payment
1. Clients receiving care under Title
					 XIX. The client's applicable income (liability) will be determined when
					 computing the ICF/MR's vendor payments. Vendor payments are subject to the
					 following conditions.
a. Vendor payments will
					 begin with the first day the client is determined to be categorically and
					 medically eligible or the date of admission, whichever is later.
b. Vendor payment will be made for the number
					 of eligible days as determined by the ICF/MR per diem rate less the client's
					 per diem applicable income.
c. If a
					 client transfers from one facility to another, the vendors' payment to each
					 facility will be calculated by multiplying the number of eligible days times
					 the ICF/MR per diem rate less the client's liability.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 103 - Standards for Payment for Intermediate Care Facilities for the Mentally Retarded (ICF/MR) › Subchapter C - Client Records › Section II-10309 - General Requirements

Current through Register Vol. 50, No. 6, June 20, 2024
NOTE: Federal regulations which pertain to this
						Subsection are as follows: 42 CFR 433 and
						42 CFR
						483.400.
A. Written Policies and Procedures. An ICF/MR
					 facility shall have written policies and procedures governing access to,
					 publication of, and dissemination of information from client records.
B. Protection of Records. Client records are
					 the property of the ICF/MR residents and as such shall be protected from loss,
					 damage, tampering, or use by unauthorized individuals. Records may be removed
					 from the ICF/MR's jurisdiction and safekeeping only in accordance with a court
					 order, subpoena or statute.
C.
					 Confidentiality. An ICF/MR facility shall ensure confidential treatment of
					 client records, including information contained in automatic data banks.
1. The client's written consent, if the
					 client is determined competent, shall be required for the release of
					 information to any persons not otherwise authorized under law to receive it. If
					 the client is not documented as competent, a member of the family, responsible
					 party or advocate shall be required to sign.
NOTE: "Blanket" signed authorizations for release of
						information from client records are time limited.
2. A record of all disclosures from client's
					 records shall be kept.
3. All staff
					 shall be trained in the policies regarding confidentiality during orientation
					 to the ICF/MR and in subsequent on-the-job and in-service training.
4. Any information concerning a client or
					 family considered too confidential for general knowledge by the ICF/MR staff
					 shall be kept in a separate file by the chief executive officer, his designee,
					 or social worker. A notation regarding the whereabouts of this information
					 shall be made in the client's record.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 103 - Standards for Payment for Intermediate Care Facilities for the Mentally Retarded (ICF/MR) › Subchapter C - Client Records › Section II-10311 - Admission Records

Current through Register Vol. 50, No. 6, June 20, 2024
A. At the time
					 of admission to the ICF/MR, information shall be entered into the client's
					 record which shall identify and give a history of the client. This identifying
					 information shall at least include the following:
1. a recent photograph;
2. full name;
3. sex;
4. date of birth;
5. ethnic group;
6. birthplace;
7. height;
8. weight;
9. color of hair and eyes;
10. identifying marks;
11. home address, including street address,
					 city, parish and state;
12. Social
					 Security Number;
13. medical
					 assistance identification number;
14. Medicare claim number, if
					 applicable;
15.
					 citizenship;
16. marital
					 status;
17. religious
					 preference;
18. language spoken or
					 understood;
19. dates of service in
					 the United States Armed Forces, if applicable;
20. legal competency status if other than
					 competent;
21. sources of support:
					 social security, Veterans benefits, etc.;
22. father's name, birthplace, social
					 security number, current address, and current phone number;
23. mother's maiden name, birthplace, social
					 security number, current address, and current phone number;
24. name, address, and phone number of next
					 of kin, legal guardian, or other responsible party;
25. date of admission;
26. name, address and telephone number of
					 referral agency or hospital;
27.
					 reason for admission;
28. admitting
					 diagnosis;
29. current diagnosis,
					 including primary and secondary DSM III diagnosis, if applicable;
30. medical information, such as allergies
					 and general health conditions;
31.
					 current legal status;
32. personal
					 attending physician and alternate, if applicable;
33. choice of other service
					 providers;
34. name of funeral
					 home, if appropriate; and
35. any
					 other useful identifying information. Refer to
Admission
					 Review
for procedures.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 103 - Standards for Payment for Intermediate Care Facilities for the Mentally Retarded (ICF/MR) › Subchapter C - Client Records › Section II-10313 - Medical Records

Current through Register Vol. 50, No. 6, June 20, 2024
A. General
					 Requirements. The ICF/MR shall maintain medical records which include clinical,
					 medical, and psychosocial information on each client.
B. Components of Medical Records. Each
					 client's record shall consist of a current active medical section and the
					 ICF/MR's medical files or folders.
1. Active
					 Medical Section. The active medical section shall contain the following
					 information:
a. at least six months of
					 current pertinent information relating to the active ongoing medical
					 care;
b. physician certification of
					 the clients' need for admission to the ICF/MR;
c. physician recertification that the client
					 continues to require the services of the ICF/MR;
d. nurses quarterly physical assessment. See
					 §10339, Client Health and Habilitation Services;
e. quarterly, the pharmacy consultant must
					 review the drug regimen of each client;
f. certification that each IHP has been
					 periodically reviewed and revised.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 103 - Standards for Payment for Intermediate Care Facilities for the Mentally Retarded (ICF/MR) › Subchapter C - Client Records › Section II-10315 - Client Personal Property Records

Current through Register Vol. 50, No. 6, June 20, 2024
NOTE: The federal regulations pertaining to this Section
						are
						42
						CFR 483.420.
A. The ICF/MR shall permit clients to
					 maintain and use their personal property. The number of personal possessions
					 may be limited only for health and safety reasons. When such limitations are
					 imposed, documentation is required in the client's records.
1. Within 24 hours after admission, the
					 ICF/MR shall prepare a written inventory of the personal property a client
					 brings to the ICF/MR.
2. The
					 facility authorized representative shall sign and retain the written inventory
					 and shall give a copy to the client, family or responsible party.
3. The ICF/MR shall revise the written
					 inventory to show if acquired property is lost, destroyed, damaged, replaced or
					 supplemented.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 103 - Standards for Payment for Intermediate Care Facilities for the Mentally Retarded (ICF/MR) › Subchapter C - Client Records › Section II-10317 - Client Financial Records

Current through Register Vol. 50, No. 6, June 20, 2024
NOTE: Federal regulations which pertain to this Section
						are
						42
						CFR 483.420(b).
A. General Requirements. Clients have the
					 right to maintain their personal funds or to designate someone to assume this
					 responsibility for them. Clients' income may be from Social Security,
					 Supplemental Security Income (SSI), optional State Supplementation, other
					 sources (VA or insurance benefits, etc.) or earnings of the client. A portion
					 of the clients' income is used to pay the clients' share (liability) of the
					 monthly charges for the ICF/MR. The ICF/MR shall:
1. have written policies and procedures for
					 protecting clients' funds and for counseling clients concerning the use of
					 their funds;
2. develop written
					 procedures for the recording and accounting of client's personal funds.
NOTE: ICF/MRs shall ensure the soundness and accuracy of
						the client fund account system.
3. train clients to manage as many of their
					 financial affairs as they are capable. Documentation must support that training
					 was provided and the results of that training.
4. maintain current records that include the
					 name of the person (client or person designated) handling each client's
					 personal funds.
5. be responsible
					 for the disbursements, deposits, soundness, and accuracy of the clients'
					 personal funds account when arrangements are made with a federal or state
					 insured banking institution to provide banking services for the clients.
NOTE: All bank charges, including charges for ordering
						checks, shall be paid by the ICF/MR and not charged to the clients' personal
						funds account(s).
6.
					 maintain current, written individual ledger sheet records of all financial
					 transactions involving client's personal funds which the facility is holding
					 and safeguarding.
NOTE: ICF/MRs shall keep these records in accordance with
						requirements of law for a trustee in a fiduciary relationship.
7. make personal fund account
					 records available upon request to the client, family, responsible party, and
					 DHH.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 103 - Standards for Payment for Intermediate Care Facilities for the Mentally Retarded (ICF/MR) › Subchapter C - Client Records › Section II-10319 - Cash on Hand

Current through Register Vol. 50, No. 6, June 20, 2024
A. ICF/MRs shall
					 have a minimum of cash on hand to meet client's spending needs. Cash on hand
					 shall be maintained on the imprest petty cash system which includes
					 pre-numbered petty cash vouchers. Petty cash shall be maintained at the
					 facility and shall be available to the clients 24 hours a day, seven days a
					 week.
B. The facility shall provide
					 the funds to implement the petty cash system and replenish it, as necessary,
					 from the clients' personal funds based on signed vouchers. Vouchers may be
					 signed by clients, families, or responsible parties. When residents cannot sign
					 their name, vouchers shall be signed by two witnesses. Checks issued to
					 replenish the fund should be made payable to "Custodian of Petty Cash." When
					 funds are withdrawn from the clients' savings account to cover signed vouchers,
					 a receipt signed by the custodian of petty cash shall be maintained in lieu of
					 a canceled check.
C. There shall be
					 a written reconciliation, at least weekly, by someone other than the custodian
					 of the petty cash fund. The reconciliation shall be reviewed and approved by
					 someone other than the preparer or custodian of the petty cash fund.
NOTE: The facility is responsible for
						shortages.
AUTHORITY NOTE:
						Promulgated in accordance with
						R.S.
						46:153.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 103 - Standards for Payment for Intermediate Care Facilities for the Mentally Retarded (ICF/MR) › Subchapter C - Client Records › Section II-10321 - Access to Funds

Current through Register Vol. 50, No. 6, June 20, 2024
A. Clients shall
					 have access to their funds during hours compatible to banking institutions in
					 the community where they live. Large ICF/MRs shall post the times when clients
					 shall have access to their funds.
AUTHORITY NOTE:
						Promulgated in accordance with
						R.S.
						46:153.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 103 - Standards for Payment for Intermediate Care Facilities for the Mentally Retarded (ICF/MR) › Subchapter C - Client Records › Section II-10323 - Closing a Discharged Client's Fund Account

Current through Register Vol. 50, No. 6, June 20, 2024
A. When a client is discharged, the ICF/MR
					 shall refund the balance of a client's personal account and that portion of any
					 advance payment not applied directly to the ICF/MR fee. The amount shall be
					 refunded to the client, family or other responsible party within 30 days
					 following the date of discharge. Date, check number, and "to close account"
					 should be noted on the ledger sheet. When the facility is the payee for a
					 Social Security check or other third party payments, the change in payee should
					 be initiated immediately by the facility.
NOTE: The facility shall allow the client to withdraw a
						minimum of $25 from his/her personal funds account on the date of
						discharge.
AUTHORITY NOTE:
						Promulgated in accordance with
						R.S.
						46:153.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 103 - Standards for Payment for Intermediate Care Facilities for the Mentally Retarded (ICF/MR) › Subchapter C - Client Records › Section II-10325 - Disposition of a Deceased Client's Personal Funds

Current through Register Vol. 50, No. 6, June 20, 2024
A. ICF/MRs, upon a client's death, shall
					 submit written notification within 10 business days to the next of kin
					 disclosing the amount of funds in the deceased's account as of the date of
					 death. The ICF/MR shall hold the funds until the next of kin notifies the
					 ICF/MR whether a succession will be opened.
1. Succession Opened. If a succession is to
					 be opened, the ICF/MR shall release the funds to the administrator of the
					 estate, if one, or according to the judgment of possession.
2. Succession Not Opened. If no succession is
					 to be opened, the ICF/MR shall make the funds payable to the deceased's estate
					 and shall release the funds to the responsible party of record.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 103 - Standards for Payment for Intermediate Care Facilities for the Mentally Retarded (ICF/MR) › Subchapter C - Client Records › Section II-10327 - Disposition of Deceased Client's Unclaimed Personal Funds

Current through Register Vol. 50, No. 6, June 20, 2024
A. If the ICF/MR retains the funds and the
					 responsible party (legal guardian, administrator of the estate, or person
					 placed in possession by the court judgment) fails to obtain the funds within
					 three months after the date of death, or if the ICF/MR fails to receive
					 notification of the appointment of or other designation of a responsible party
					 within three months after the death, the ICF/MR shall notify the secretary of
					 the Department of Revenue, Unclaimed Property Section. The notice shall provide
					 detailed information about the decedent, his next of kin, and the amount of
					 funds.
1. The facility shall continue to
					 retain the funds until a court order specifies that the funds are to be turned
					 over to secretary of the Department of Revenue.
2. If no order or judgment is forthcoming,
					 the ICF/MR shall retain the funds for five years after date of death.
3. After five years, the ICF/MR is
					 responsible for delivering the unclaimed funds to the secretary of
					 Revenue.
4. A termination date of
					 the account and the reason for termination shall be recorded on the client's
					 participation file. A notation shall read, "to close account." The endorsed
					 canceled check with check number noted on the ledger sheet shall serve as
					 sufficient receipt and documentation.
5. Where the legislature has enacted a law
					 governing the disposition of personal funds belonging to residents of state
					 schools for the mentally retarded or developmentally disabled that law shall be
					 applicable.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 103 - Standards for Payment for Intermediate Care Facilities for the Mentally Retarded (ICF/MR) › Subchapter D - Transfers and Discharges › Section II-10329 - Written Agreements with Outside Resources

Current through Register Vol. 50, No. 6, June 20, 2024
The federal regulations pertaining to this Section are
						483.410(d), 483.410(d)(1) through 483.410(d)(2)(ii) and 483.440(b)(1) through
						483.440(b)(5)(ii).
A. Each client must
					 have the services which are required to meet his needs including emergency and
					 other health care. If the service is not provided directly, there must be a
					 written agreement with an outside resource. The written agreement for hospital
					 transfers must be with hospitals within close proximity and must provide for
					 prompt transfer of clients.
AUTHORITY NOTE:
						Promulgated in accordance with
						R.S.
						46:153.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 103 - Standards for Payment for Intermediate Care Facilities for the Mentally Retarded (ICF/MR) › Subchapter D - Transfers and Discharges › Section II-10331 - Facility Responsibilities for Planned or Voluntary Transfer or Discharge Policies Requirements

Current through Register Vol. 50, No. 6, June 20, 2024
A. Facility
					 record shall document that the client was transferred or discharged for good
					 cause which means for any reason that is in the best interest of the
					 individual.
B. Any decision to move
					 a client shall be part of an interdisciplinary team process. The client,
					 family, legal representative, and advocate, if there is one, shall participate
					 in the decision making process.
C.
					 Planning for a client's discharge or transfer shall allow for at least 30 days
					 to prepare the client and parents/guardian for the change except in
					 emergencies.
D. Planning for
					 release of a client shall include providing for appropriate services in the
					 client's new environment, including protective supervision and other follow-up
					 services which are detailed in his discharge plan.
E. The client and/or legal representative
					 must give their written consent to all non-emergency situations. Notification
					 shall be made to the parents or guardians as soon as possible.
F. Both the discharging and receiving
					 facilities shall share responsibility for ensuring the interchange of medical
					 and other programmatic information which shall include:
1. an updated active treatment
					 plan;
2. appropriate transportation
					 and care of the client during transfer; and
3. the transfer of personal effects and of
					 information related to such items;
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 103 - Standards for Payment for Intermediate Care Facilities for the Mentally Retarded (ICF/MR) › Subchapter D - Transfers and Discharges › Section II-10333 - Involuntary Transfer or Discharge

Current through Register Vol. 50, No. 6, June 20, 2024
A. Conditions. Involuntary transfer or
					 discharge of a client may occur only under the following conditions:
1. the transfer or discharge is necessary for
					 the client's welfare and the client's needs cannot be met in the
					 facility;
2. the transfer or
					 discharge is appropriate because the client's health has improved sufficiently,
					 therefore, the client no longer needs the services provided by the
					 facility;
3. the safety of
					 individuals in the facility is endangered;
4. the health of individuals in the facility
					 would otherwise be endangered;
5.
					 the client has failed, after reasonable and appropriate notice, to pay for the
					 portion of the bill for services for which he/she is liable or when the client
					 loses financial eligibility for Medicaid. When a client becomes eligible for
					 Medicaid after admission to a facility, the facility may charge the client only
					 allowable charges under Medicaid; and
6. the facility ceases to operate.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 103 - Standards for Payment for Intermediate Care Facilities for the Mentally Retarded (ICF/MR) › Subchapter D - Transfers and Discharges › Section II-10335 - Mass Transfer of Clients

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
					 following provisions shall apply to any mass transfer:
1. ICF/MR Decertification. When DHH/BHSF
					 determines that an ICF/MR no longer meets state and federal Title XIX
					 certification requirements, decertification action is taken. Usually an advance
					 decertification date is set unless clients are in immediate danger.
2. ICF/MR Decertification Notice. On the date
					 the ICF/MR is notified of its decertification, DHH shall begin notifying
					 clients, families, responsible parties, and other appropriate agencies or
					 individuals of the decertification action and of the services available to
					 ensure an orderly transfer and continuity of care.
3. ICF/MR Closing or Withdrawing from Title
					 XIX Program. In institutions where an ICF/MR either voluntarily or
					 involuntarily discontinues its operations or participation in the Medical
					 Assistance Program, clients, families, responsible parties, and other
					 appropriate agencies or individuals shall be notified as far in advance of the
					 effective date as possible to insure an orderly transfer and continuity of
					 care.
a. If the ICF/MR is closing its
					 operations, plans shall be made for transfer.
b. If the ICF/MR is voluntarily or
					 involuntarily withdrawing from Title XIX participation, the client has the
					 option of remaining in the ICF/MR on a private-pay basis.
4. Payment Limitation. Payments may continue
					 for clients up to 30 days following the effective date of the ICF/MR's
					 decertification.
a. There shall be no
					 payments approved for Title XIX clients admitted after an ICF/MR receives a
					 notice of decertification.
b. The
					 payment limitation also applies to Title XIX clients admitted prior to the
					 decertification notice.
c. Payment
					 is continued to the ICF/MR for clients certified prior to the decertification
					 only if the ICF/MR totally cooperates in the orderly transfer of clients to
					 other Title XIX facilities or other placements of their choice.
NOTE: The ICF/MR's failure to comply with the transfer
						team's requests may result in denial of reimbursement during the extension
						period.
NOTE: The ICF/MR still retains its usual responsibility
						during the transfer/discharge process to notify the BHSF Medicaid Eligibility
						Parish Office promptly of all changes in the client's status.
5. Client Rights. Nothing in the
					 transfer or discharge plan shall interfere with client's exercise of his
					 rights.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 103 - Standards for Payment for Intermediate Care Facilities for the Mentally Retarded (ICF/MR) › Subchapter E - Facility Records › Section II-10337 - General Requirements

Current through Register Vol. 50, No. 6, June 20, 2024
NOTE: The federal regulations which pertain to this
						Section are 42 CFR 433 and 42 CFR 442.
A. The ICF/MR shall retain such records on
					 file as required by DHH and shall have them available for inspection at request
					 for three years from the date of service or until all audit exceptions are
					 resolved, whichever period is longer.
B. Provider Agreement. The ICF/MR shall
					 retain a copy of the Provider Agreement and any document pertaining to the
					 licensing or certification of the ICF/MR.
C. Accounting Records
1. Accounting records must be maintained in
					 accordance with generally accepted accounting principles as well as state and
					 federal regulations. The accrual method of accounting is the only acceptable
					 method for private providers.
NOTE: Purchase discounts, allowance and refunds will be
						recorded as a reduction of the cost to which they related.
2. Each facility must maintain all accounting
					 records, books, invoices, canceled checks, payroll records, and other documents
					 relative to client care costs for a period of three years or until all audit
					 exceptions are resolved, whichever period is longer.
3. All fiscal and other records pertaining to
					 client care costs shall be subject at all times to inspection and audit by DHH,
					 the legislative auditor, and auditors of appropriate federal funding
					 agencies.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 103 - Standards for Payment for Intermediate Care Facilities for the Mentally Retarded (ICF/MR) › Subchapter F - Health Services › Section II-10341 - Client Behavior

Current through Register Vol. 50, No. 6, June 20, 2024
NOTE: The federal regulations pertaining to this Section
						are
						42
						CFR 483.420,
						483.440,
						and
						483.450.
						The state laws pertaining to this Section are R.S. 40.2009.2-RS. 40:2009.20 and
						R.S. 403.2.
A. Written Policies and
					 Procedures
1. A facility must develop and
					 implement written policies and procedures for the management of conduct between
					 staff and clients. These policies and procedures will:
a. specify conduct to be allowed and not
					 allowed by staff and/or clients;
b.
					 provide for client choice and self determination to the extent
					 possible;
c. be readily available
					 to all clients, parent(s), staff, and legal guardians;
d. be developed with the participation of
					 clients to the extent possible.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 103 - Standards for Payment for Intermediate Care Facilities for the Mentally Retarded (ICF/MR) › Subchapter F - Health Services › Section II-10343 - Client Rights

Current through Register Vol. 50, No. 6, June 20, 2024
NOTE:
Code of Federal Regulations
pertaining to this Section are as follows:
						42
						CFR 483.420 and
						483.410(1),
						(2), (3). Federal laws pertaining to this
						Section are as follows: Section 601 of Title VI of the Civil Rights Act of
						1964; Section 504 of the Rehabilitation Act of 1973; and Age Discrimination Act
						of 1975. The state law pertaining to this Section is R.S. 28.390 Rights
						Law.
A. Written Policies. The ICF/MR
					 will establish written policies that safeguard clients' rights and define their
					 responsibilities. The ICF/MR chief executive officer and ICF/MR staff will be
					 trained in and will adhere to client rights policies and procedures. ICF/MR
					 personnel will protect and promote clients' civil rights and rights to a
					 dignified existence, self-determination, communication with and access to
					 persons and services inside and outside the facility and to exercise their
					 legal rights. The chief executive officer will be responsible for staff
					 compliance with client rights policies.
B. Notification of Rights
1. All clients, families, and/or responsible
					 parties will sign a statement that they have been fully informed verbally and
					 in writing of the following information at the time of admission and when
					 changes occur during the client's stay in the facility:
a. the facility's rules and
					 regulations;
b. their
					 rights;
c. their responsibilities
					 to obey all reasonable rules and regulations and respect the personal rights
					 and private property of clients; and
d. rules for conduct at the time of their
					 admissions and subsequent changes during their stay in the facility.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 103 - Standards for Payment for Intermediate Care Facilities for the Mentally Retarded (ICF/MR) › Subchapter F - Health Services › Section II-10345 - Complaints

Current through Register Vol. 50, No. 6, June 20, 2024
A. Purpose and
					 Scope. Under the provisions of Louisiana R.S. 40:2009.13-40:2009.20 and 14:4032
					 federal regulation
					 42 CFR
					 483.405,
					 483.420,
					 483.440
					 and the state Operations Manual published by the Department of Health and
					 Hospitals and Health Care Financing Administration, the following procedures
					 are established for receiving, evaluating, investigating, and correcting
					 grievances concerning client care in ICF/MR licensed and certified ICF/MR
					 facilities. The following procedures also provide mandatory reporting of abuse
					 and neglect in ICF/MR facilities.
B. Applicability
1. Any person having knowledge of the alleged
					 abuse or neglect of a client or knowledge of a client being denied care and
					 treatment may submit a complaint, preferably in writing.
2. Any person may submit a complaint if
					 he/she has knowledge that a state law, standard, rule, regulation, correction
					 order, or certification rule issued by the Department of Health and Hospitals
					 has been violated.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 103 - Standards for Payment for Intermediate Care Facilities for the Mentally Retarded (ICF/MR) › Subchapter G - Admission Review › Section II-10347 - The Admission Process

Current through Register Vol. 50, No. 6, June 20, 2024
NOTE: Federal regulations pertaining to this Section are
						42 CFR
						456.350 -
						456.438.
						ICF/MRs will be subject to a review of each client's need for ICF/MR
						services.
A. Interdisciplinary Team
					 (ID Team). Before admission to an ICF/MR, or before authorization for payment,
					 an interdisciplinary team of health professionals will make a comprehensive
					 medical, social and psychological evaluation of each client's need for care in
					 the ICF/MR.
1. Other professionals as
					 appropriate will be included on the team, and at least one member will meet the
					 definition of Qualified Mental Retardation Professional (QMRP) as stated in
					 these standards.
2. Appropriate
					 participation of nursing services on this team should be represented by a
					 Louisiana licensed nurse.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 103 - Standards for Payment for Intermediate Care Facilities for the Mentally Retarded (ICF/MR) › Subchapter G - Admission Review › Section II-10349 - Requirements for Certification

Current through Register Vol. 50, No. 6, June 20, 2024
A.
					 The following documentation and procedures are required to obtain medical
					 certification for ICF/MR Medicaid vendor payment. The documentation should be
					 submitted to the appropriate HSS Regional Office.
1. Social evaluation:
a. must not be completed more than 90 days
					 prior to admission and no later than date of admission; and
b. must address the following:
i. family, educational and social history
					 including any previous placements;
ii. treatment history that discusses past and
					 current interventions, treatment effectiveness, and encountered negative side
					 effects;
iii. current living
					 arrangements;
iv. family
					 involvement, if any;
v.
					 availability and utilization of community, educational, and other sources of
					 support;
vi. habilitation
					 needs;
vii. family and/or client
					 expectations for services;
viii.
					 prognosis for independent living; and
ix. social needs and recommendation for
					 ICF/MR placement.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 103 - Standards for Payment for Intermediate Care Facilities for the Mentally Retarded (ICF/MR) › Subchapter G - Admission Review › Section II-10353 - Utilization Reviews

Current through Register Vol. 50, No. 6, June 20, 2024
NOTE: Federal regulations pertaining to ICFs are found at
						42 CFR
						456.350 through
						456.438.
A. If it is determined by HSS that continued
					 stay is not needed, the client's attending physician or Qualified Mental
					 Retardation Professional (QMRP) shall be notified within one working day and
					 given two working days from the notification date to present his/her views
					 before a final decision on continued stay is made.
B. If the attending physician or QMRP does
					 not present additional information or clarification of the need for continued
					 stay, the decision of the UR group is final.
C. If the attending physician or QMRP
					 presents additional information or clarification, the need for continued stay
					 is reviewed by the physician member(s) of the UR group in cases involving a
					 medical determination.
D. The
					 decision of the UR group is the final medical eligibility decision. Recourse
					 for the client is to exercise his/her appeal rights according to the
					 Administrative Procedure Act.
AUTHORITY NOTE:
						Promulgated in accordance with
						R.S.
						46:153.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 103 - Standards for Payment for Intermediate Care Facilities for the Mentally Retarded (ICF/MR) › Subchapter G - Admission Review › Section II-10355 - Appeals

Current through Register Vol. 50, No. 6, June 20, 2024
NOTE:
Code of Federal Regulations
that
						pertain to this Section are as follows:
						42 CFR
						431.151 through
						431.154.
A. DHH reserves the right to reject a request
					 for Title XIX participation, impose sanctions or terminate participation status
					 when an ICF/MR:
1. fails to abide by the
					 rules and regulations promulgated by DHH;
2. fails to obtain compliance or is otherwise
					 not in compliance with Title VI of the Civil Rights Act;
3. engages in practice not in the best
					 interest of Medicaid (Title XIX) clients;
4. has previously been sanctioned for
					 violation of state and/or federal rules and regulations; or
5. has previously been decertified from
					 participation as a Title XIX provider. Prior to such rejection or termination,
					 DHH may conduct an Informal Reconsideration at the ICF/MR's request. The ICF/MR
					 also has the right to an Administrative Appeal pursuant to the Administrative
					 Procedure Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 103 - Standards for Payment for Intermediate Care Facilities for the Mentally Retarded (ICF/MR) › Subchapter G - Admission Review › Section II-10357 - Sanctions

Current through Register Vol. 50, No. 6, June 20, 2024
A. Noncompliance.
					 When ICF/MRs are not in compliance with the requirements set forth in the
					 ICF/MR Standards for Payment, DHH may impose sanctions. Sanctions may involve:
1. withholding of vendor payments;
2. civil fines;
3. denial of payments for new admissions;
					 or
4. nonfinancial measures such as
					 termination of the ICF/MR's certification as a Title XIX provider.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 103 - Standards for Payment for Intermediate Care Facilities for the Mentally Retarded (ICF/MR) › Subchapter H - Emergency Awareness › Section II-10365 - Disaster Preparedness

Current through Register Vol. 50, No. 6, June 20, 2024
A. Written
					 Plans. ICFs/MR shall have written procedures complete with instructions to be
					 followed in the event of an internal or external disaster such as fire or other
					 emergency actions, including:
1.
					 specifications of evacuation routes and procedures;
2. instructions for the care of injuries
					 and/or casualties (client and personnel) arising from such disaster;
3. procedures for the prompt transfer of
					 records;
4. instructions regarding
					 methods of containing fire; and
5.
					 procedures for notification of appropriate persons.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 103 - Standards for Payment for Intermediate Care Facilities for the Mentally Retarded (ICF/MR) › Subchapter H - Emergency Awareness › Section II-10375 - Cost Reports

Current through Register Vol. 50, No. 6, June 20, 2024
A. Intermediate
					 Care Facilities for the Mentally Retarded (ICFs-MR) are required to file annual
					 cost reports to the bureau in accordance with the following instructions.
1. Each ICF-MR is required to report all
					 reasonable and allowable costs on a regular facility cost report including any
					 supplemental schedules designated by the bureau.
2. Separate cost reports must be submitted by
					 central/home offices and habilitation programs when costs of those entities are
					 reported on the facility cost report.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 103 - Standards for Payment for Intermediate Care Facilities for the Mentally Retarded (ICF/MR) › Subchapter H - Emergency Awareness › Section II-10377 - Rate Determination

Current through Register Vol. 50, No. 6, June 20, 2024
A. Resident
					 per diem rates are calculated based on information reported on the cost report.
					 ICFs-MR will receive a rate for each resident. The rates are based on cost
					 components appropriate for an economic and efficient ICF-MR providing quality
					 service. The resident per diem rates represent the best judgment of the state
					 to provide reasonable and adequate reimbursement required to cover the costs of
					 economic and efficient ICFs-MR.
B.
					 The cost data used in setting base rates will be from the latest available
					 audited or desk reviewed cost reports. The initial rates will be adjusted to
					 maintain budget neutrality upon transition to the ICAP reimbursement
					 methodology. For rate periods between rebasing, the rates will be trended
					 forward using the index factor contingent upon appropriation by the
					 legislature.
C. For dates of
					 service on or after August 1, 2005, a resident's per diem rate will be the sum
					 of:
1. direct care per diem rate;
2. care related per diem rate;
3. administrative and operating per diem
					 rate;
4. capital rate;
					 and
5. provider fee.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 103 - Standards for Payment for Intermediate Care Facilities for the Mentally Retarded (ICF/MR) › Subchapter H - Emergency Awareness › Section II-10379 - ICAP Requirements

Current through Register Vol. 50, No. 6, June 20, 2024
A. An ICAP
					 must be completed for each recipient of ICF-MR services upon admission and
					 while residing in an ICF-MR in accordance with departmental
					 regulations.
B. Providers must keep
					 a copy of the recipient's current ICAP protocol and computer scored summary
					 sheets in the recipient's file. If a recipient has changed ICAP service level,
					 providers must also keep a copy of the recipient's ICAP protocol and computer
					 scored summary sheets supporting the prior level.
C. ICAPs must reflect the resident's current
					 level of care.
D. Providers must
					 submit a new ICAP to the Regional Health Standards office when the resident's
					 condition reflects a change in the ICAP level that indicates a change in
					 reimbursement.
AUTHORITY NOTE:
						Promulgated in accordance with
						R.S.
						36:254 and Title XIX of the Social Security
						Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 103 - Standards for Payment for Intermediate Care Facilities for the Mentally Retarded (ICF/MR) › Subchapter H - Emergency Awareness › Section II-10381 - ICAP Monitoring

Current through Register Vol. 50, No. 6, June 20, 2024
A. ICAP
					 scores and assessments will be subject to review by DHH and its contracted
					 agents. The reviews of ICAP submissions include, but are not limited to:
1. reviews when statistically significant
					 changes occur within an ICAP submission or submissions;
2. random selections of ICAP
					 submissions;
3. desk reviews of a
					 sample of ICAP submissions; and
4.
					 on-site field reviews of ICAPs.