reglab/statecodes huggingface dataset:
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 1 - General Provisions › Chapter 9 - Provider Requirements › Subchapter A - General Provisions › Section XXI-905 - Critical Incident Reporting

Current through Register Vol. 50, No. 6, June 20, 2024
A. Support
					 coordination and direct service provider types are responsible for documenting
					 the occurrence of incidents or accidents that affect the health and welfare of
					 the participant, and for completing an incident report.
B. The incident report shall be submitted to
					 the department, or its designee, with the specified requirements and within
					 specified time lines.
C. Specific
					 requirements and timelines are outlined in each program offices
Critical Incident Reporting Policy and Procedures
document.
Implementation of the provisions of this Rule may be
						contingent upon the approval of the U.S. Department of Health and Human
						Services, Centers for Medicare and Medicaid Services (CMS), if it is determined
						that submission to CMS for review and approval is required.
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 XXI - Home and Community-Based Services Waivers › Subpart 1 - General Provisions › Chapter 11 - Fiscal Employer Agent Standards for Participation in Home and Community-Based Services Waiver Programs › Subchapter A - General Provisions › Section XXI-1101 - Introduction

Current through Register Vol. 50, No. 6, June 20, 2024
A. The Department
					 of Health (LDH) establishes these minimum standards for participation as a
					 fiscal employer agent (F/EA). These standards provide the core requirements for
					 financial management services provided under home and community-based services
					 waiver programs administered by the Office of Aging and Adult Services (OAAS),
					 the Office for Citizens with Developmental Disabilities (OCDD), and the Bureau
					 of Health Services Financing (BHSF).
B. LDH is responsible for setting the
					 standards for F/EAs, monitoring the provisions of this Rule, and applying
					 administrative sanctions for failures to meet the minimum standards for
					 participation in serving employers/participants of the OAAS and
					 OCDD-administered waiver programs.
C. The F/EA provides financial management
					 services for participants who are eligible for self-directed waiver services.
					 Under this service model, the F/EA assists individuals with management of
					 fiscal employment and/or budget responsibilities and will provide the
					 employer/participant with current utilization information to ensure
					 self-directed services are not exceeded beyond the prior authorization cap;
					 processes employer-related payroll and necessary taxes on behalf of
					 self-direction participants. The F/EA also verifies qualifications (e.g.,
					 background checks, exclusion checks, etc.) for employees hired by the
					 employers.
D. Medicaid-enrolled
					 F/EAs providing financial management services at the time of OCDD and
					 OAAS-administered waiver programs shall be required to meet the requirements of
					 this Chapter.
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 XXI - Home and Community-Based Services Waivers › Subpart 1 - General Provisions › Chapter 11 - Fiscal Employer Agent Standards for Participation in Home and Community-Based Services Waiver Programs › Subchapter A - General Provisions › Section XXI-1103 - Certification Requirements

Current through Register Vol. 50, No. 6, June 20, 2024
A. All
					 F/EAs that provide financial management services must be certified through
					 completion of a readiness review by LDH. It shall be unlawful to operate as an
					 F/EA without being certified by LDH.
B. In order to provide financial management
					 services, the F/EA must:
1. be certified
					 through completion of a readiness review and meet the standards for
					 participation requirements as set forth in this Rule;
2. sign a performance agreement with
					 LDH;
3. enroll as an F/EA with the
					 Louisiana Medicaid program to provide services for OCDD and OAAS-administered
					 home and community-based services; and
4. comply with all policies and procedures
					 set forth by LDH.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 1 - General Provisions › Chapter 11 - Fiscal Employer Agent Standards for Participation in Home and Community-Based Services Waiver Programs › Subchapter A - General Provisions › Section XXI-1105 - Certification Issuance

Current through Register Vol. 50, No. 6, June 20, 2024
A. A
					 certification shall:
1. be issued only to the
					 F/EA named in the certification application;
2. be valid only for the F/EA to which it is
					 issued after all applicable requirements are met;
3. enable the F/EA to provide financial
					 management services for OCDD and OAAS-administered home and community-based
					 services waivers statewide;
4. be
					 valid indefinitely, unless revoked, suspended, modified, or terminated;
					 and
5. be issued by LDH.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 1 - General Provisions › Chapter 11 - Fiscal Employer Agent Standards for Participation in Home and Community-Based Services Waiver Programs › Subchapter A - General Provisions › Section XXI-1107 - Certification Refusal or Revocation and Fair Hearing

Current through Register Vol. 50, No. 6, June 20, 2024
A. A certification may be revoked or refused
					 if applicable certification requirements, as determined by LDH, have not been
					 met. Certification decisions are subject to appeal and fair hearing, in
					 accordance with
					 R.S.
					 46:107(A)(3).
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 XXI - Home and Community-Based Services Waivers › Subpart 1 - General Provisions › Chapter 11 - Fiscal Employer Agent Standards for Participation in Home and Community-Based Services Waiver Programs › Subchapter A - General Provisions › Section XXI-1109 - Certification Review

Current through Register Vol. 50, No. 6, June 20, 2024
A. Compliance
					 with certification requirements is determined by LDH through its F/EA
					 monitoring processes. Monitors must be given access to data upon request by LDH
					 to ensure the F/EA continues to meet certification requirements.
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 XXI - Home and Community-Based Services Waivers › Subpart 1 - General Provisions › Chapter 11 - Fiscal Employer Agent Standards for Participation in Home and Community-Based Services Waiver Programs › Subchapter B - Administration and Organization › Section XXI-1115 - Governing Body

Current through Register Vol. 50, No. 6, June 20, 2024
A. The F/EA shall
					 have an identifiable governing body with responsibility for and authority over
					 its policies and activities.
B. The
					 F/EA shall have documents identifying all members of the governing body, their
					 addresses, their terms of membership, and officers of the governing
					 body.
C. The governing body of the
					 F/EA shall:
1. ensure continual compliance
					 and conformity with all relevant federal, state, local, and municipal laws and
					 regulations;
2. ensure the F/EA is
					 adequately funded and fiscally sound;
3. review and approve the F/EA's annual
					 budget; and
4. designate a person
					 to act as administrator and delegate sufficient authority to this person to
					 manage the F/EA.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 1 - General Provisions › Chapter 11 - Fiscal Employer Agent Standards for Participation in Home and Community-Based Services Waiver Programs › Subchapter B - Administration and Organization › Section XXI-1117 - Business Location and Operations

Current through Register Vol. 50, No. 6, June 20, 2024
A. The F/EA shall have a business location
					 which shall not be in an occupied personal residence. The F/EA must maintain
					 the following at the business location:
1.
					 staff to perform administrative functions;
2. direct service worker/employee personnel
					 records; and
3. participant service
					 records.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 1 - General Provisions › Chapter 11 - Fiscal Employer Agent Standards for Participation in Home and Community-Based Services Waiver Programs › Subchapter B - Administration and Organization › Section XXI-1119 - Financial Management

Current through Register Vol. 50, No. 6, June 20, 2024
A. The F/EA
					 must establish a system of financial management and staffing to assure
					 maintenance of complete and accurate accounts, books, and records in keeping
					 with generally accepted accounting principles.
B. The F/EA must not permit public funds to
					 be paid, or committed to be paid, to any person who is a member of the
					 governing board or administrative personnel who may have any direct or indirect
					 financial interest, or in which any of these persons serve as an officer or
					 employee, unless the services or goods involved are provided at a competitive
					 cost or under terms favorable to the F/EA.
1.
					 The F/EA shall have a written disclosure of any financial transaction with the
					 F/EA in which a member of the governing board, administrative personnel, or
					 his/her immediate family is involved.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 1 - General Provisions › Chapter 11 - Fiscal Employer Agent Standards for Participation in Home and Community-Based Services Waiver Programs › Subchapter B - Administration and Organization › Section XXI-1121 - Policy and Procedures

Current through Register Vol. 50, No. 6, June 20, 2024
A. The F/EA
					 shall have written policies and procedures approved by the owner or governing
					 body which must be implemented and followed that address at a minimum the
					 following:
1. confidentiality and
					 confidentiality agreements;
2.
					 security of files;
3. publicity and
					 marketing, including the prohibition of illegal or coercive inducement,
					 solicitation, and kickbacks;
4.
					 personnel;
5. grievance
					 procedures;
6. emergency
					 preparedness;
7. procedures for
					 reporting suspected abuse, neglect, exploitation, and extortion;
8. procedures for reporting suspected
					 fraud;
9. documentation;
					 and
10. enrollment/disenrollment
					 procedures.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 1 - General Provisions › Chapter 11 - Fiscal Employer Agent Standards for Participation in Home and Community-Based Services Waiver Programs › Subchapter B - Administration and Organization › Section XXI-1123 - Organizational Communication

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
					 F/EA must establish procedures to assure adequate communication among staff to
					 provide continuity of services to the participant and to facilitate feedback
					 from staff, participants, families, and when appropriate, the
					 community.
B. The F/EA must have
					 brochures and make them available to LDH or its designee. The brochures must
					 include the following information:
1. a
					 toll-free number and email address to direct customer service questions or to
					 receive assistance;
2. information
					 on how to make a complaint if they are dissatisfied with F/EA services;
					 and
3. a description of the F/EA,
					 services provided, current mailing and physical addresses, website information,
					 and the F/EA's toll-free number.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 1 - General Provisions › Chapter 11 - Fiscal Employer Agent Standards for Participation in Home and Community-Based Services Waiver Programs › Subchapter C - Provider Responsibilities › Section XXI-1129 - General Provisions

Current through Register Vol. 50, No. 6, June 20, 2024
A. Any
					 entity wishing to provide F/EA services shall meet all of the standards for
					 participation contained in this Rule, unless otherwise specifically noted
					 within these provisions.
B. The
					 F/EA shall also abide by and adhere to any federal and state law, Rule, policy,
					 procedure, performance agreement, or other state or federal requirements
					 pertaining to the provision of F/EA services.
C. Failure to comply with the requirements of
					 these standards for participation may result in the following actions
					 including, but not limited to:
1. recoupment
					 of funds;
2. sanctions for
					 violations/non-performance as outlined in the performance agreement;
3. citation of deficient practice and plan of
					 correction submission;
4. removal
					 from the F/EA freedom of choice list; or
5. decertification as an F/EA and termination
					 of the F/EA's Medicaid provider enrollment.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 1 - General Provisions › Chapter 11 - Fiscal Employer Agent Standards for Participation in Home and Community-Based Services Waiver Programs › Subchapter C - Provider Responsibilities › Section XXI-1131 - Fiscal Employer Agent Requirements

Current through Register Vol. 50, No. 6, June 20, 2024
A.
					 The F/EA must comply with requirements for financial management services in
					 self-direction including, but not limited to:
1. verifying qualifications of employers and
					 support workers;
2. processing
					 payroll, including applying applicable withholds and filing/paying all required
					 state and federal income taxes;
3.
					 disbursing payment to direct support workers;
4. setting up accounting records to track
					 expenses;
5. setting up procedures
					 for processing payroll and non-labor items;
6. maintaining all records related to the
					 direct support worker's payroll, taxes, and benefits;
7. producing and sending required reports to
					 LDH;
8. providing support to
					 self-direction employers;
9.
					 billing the LDH fiscal intermediary for Medicaid service claims and making
					 refunds to LDH as appropriate;
10.
					 resolving all billing discrepancies timely;
11. utilizing an LDH approved payroll
					 calendar that addresses tax obligations; and
12. utilizing a system capable of capturing,
					 recording, and tracking service, payroll, and tax information.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 1 - General Provisions › Chapter 11 - Fiscal Employer Agent Standards for Participation in Home and Community-Based Services Waiver Programs › Subchapter C - Provider Responsibilities › Section XXI-1133 - Transfers and Discharges

Current through Register Vol. 50, No. 6, June 20, 2024
A.
					 Participant has the right to choose among the F/EAs certified by LDH and
					 enrolled in the Louisiana Medicaid Program. This includes the right to
					 transition to another F/EA.
B. Upon
					 notice by the participant or his/her authorized representative that the
					 participant has selected another F/EA or the participant has decided to
					 discontinue participation in the self-direction program, the F/EA is
					 responsible for planning and facilitating the participant's transfer or
					 discharge.
C. The F/EA shall
					 facilitate transfer to another F/EA when it ceases to operate or its Medicaid
					 enrollment is terminated.
D. The
					 transfer or transition responsibilities of the F/EA shall include:
1. working with the F/EA selected by the
					 participant to transition by ensuring the following documents/information are
					 submitted to the new provider: participant/employer wages, federal employment
					 identification number (FEIN), and state unemployment tax act (SUTA) account
					 information including username and password;
2. ensuring that there is only one F/EA for a
					 given employer at any time;
3.
					 adhering to specific processes and procedures when transitioning a participant
					 to a new F/EA in accordance with all federal, state, and local laws;
					 and
4. documenting the activities
					 that are required to transition the participant to the receiving
					 F/EA.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 1 - General Provisions › Chapter 11 - Fiscal Employer Agent Standards for Participation in Home and Community-Based Services Waiver Programs › Subchapter C - Provider Responsibilities › Section XXI-1135 - Staffing Requirements

Current through Register Vol. 50, No. 6, June 20, 2024
A. F/EAs
					 must maintain sufficient staff to comply with LDH regulations and policies for
					 the self-direction program. The F/EA shall:
1. employ at least one staff member with a
					 bachelor's degree in accounting and five years of applicable experience, or a
					 master's degree in accounting and two years of applicable experience, or a
					 master's degree in accounting and two years of applicable experience;
2. must have on staff a database administer
					 and sufficient programmers to ensure that systems comply with program
					 requirements and are flexible enough to accommodate changes to those
					 requirements; and
3. must designate
					 a project director who will have day-to-day authority to manage the overall
					 operations.
a. The project director will be
					 available to LDH by telephone, e-mail, and video conferencing during regular
					 business hours.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 1 - General Provisions › Chapter 11 - Fiscal Employer Agent Standards for Participation in Home and Community-Based Services Waiver Programs › Subchapter C - Provider Responsibilities › Section XXI-1137 - Employer Rights

Current through Register Vol. 50, No. 6, June 20, 2024
A. Each F/EA's
					 written policies and procedures, at a minimum, shall ensure the employer's
					 right to:
1. confidentiality;
2. privacy;
3. impartial access to F/EA services
					 regardless of race, religion, sex, ethnicity, or disability;
4. access to the interpretive services,
					 translated material and similar accommodations as appropriate;
5. access to his/her records upon the
					 participant's written consent for release of information;
6. an explanation of the nature of services
					 to be received;
7. file a complaint
					 or grievance without retribution, retaliation, or discharge;
8. have access to information related to
					 tracking their budget and service balance; and
9. discontinue services with their F/EA and
					 choose another F/EA.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 1 - General Provisions › Chapter 11 - Fiscal Employer Agent Standards for Participation in Home and Community-Based Services Waiver Programs › Subchapter C - Provider Responsibilities › Section XXI-1139 - Grievances

Current through Register Vol. 50, No. 6, June 20, 2024
A. The F/EA shall
					 establish and follow a written grievance procedure to be used to process
					 complaints by employers, their family member(s), or a legal representative that
					 is designed to allow employers to make complaints without fear of retaliation.
					 The written grievance procedure shall be provided to the employer.
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 XXI - Home and Community-Based Services Waivers › Subpart 1 - General Provisions › Chapter 11 - Fiscal Employer Agent Standards for Participation in Home and Community-Based Services Waiver Programs › Subchapter C - Provider Responsibilities › Section XXI-1141 - Electronic Visit Verification (EVV) Requirements

Current through Register Vol. 50, No. 6, June 20, 2024
A. The F/EA must have an electronic visit
					 verification (EVV) system in place that complies with the 21st Century Cures
					 Act. The F/EA's EVV system must verify the type of service provided, the
					 individual receiving the service, the individual providing the service, date of
					 service, location of the service (geolocation), and time the service begins and
					 ends.
B. Services may be verified
					 via smart phone, telephony (landline from participant's home), or a fixed visit
					 verification device in the participant's home. Other methods of verification
					 may be submitted to LDH for consideration and approval.
C. The F/EA is responsible for ensuring the
					 system used meets the requirements specified in the LDH attestation for third
					 party EVV systems.
1. The system shall have
					 the capability to interface with LDH's EVV system.
2. The F/EA's system and its interface shall
					 pass testing required by the data integration process prior to
					 go-live.
3. The F/EA will be
					 required to collect electronic check in/check out information including
					 geolocation data in accordance with state requirements.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 1 - General Provisions › Chapter 11 - Fiscal Employer Agent Standards for Participation in Home and Community-Based Services Waiver Programs › Subchapter C - Provider Responsibilities › Section XXI-1143 - Employer Records

Current through Register Vol. 50, No. 6, June 20, 2024
A. The F/EA
					 shall store employer/employee records securely and protected in accordance with
					 HIPAA requirements at the F/EA's place of business.
B. F/EAs shall maintain employer and employee
					 records for at least six years or longer when required by state or federal
					 law.
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 XXI - Home and Community-Based Services Waivers › Subpart 1 - General Provisions › Chapter 11 - Fiscal Employer Agent Standards for Participation in Home and Community-Based Services Waiver Programs › Subchapter C - Provider Responsibilities › Section XXI-1145 - Emergency Preparedness

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
					 F/EA, regardless of the architecture of its systems, shall develop and be
					 continually ready to invoke an all hazards plan to protect the availability,
					 integrity, and security of data during unexpected failures or disasters (either
					 natural or man-made) to continue essential application or system functions
					 during or immediately following failures or disasters.
B. The all hazards plan shall include a
					 disaster recovery plan (DRP) and a business continuity plan (BCP). A DRP is
					 designed to recover systems, networks, workstations, applications, etc., in the
					 event of a disaster. A BCP shall focus on restoring the operational function of
					 the organization in the event of a disaster and includes items related to
					 information technology (IT), as well as operational items such as employee
					 notification processes and the procurement of office supplies needed to do
					 business in the emergency mode operation environment. The practice of including
					 both the DRP and the BCP in the all hazards planning process is a best
					 practice. At a minimum, the all hazards plan shall address the following
					 scenarios:
1. the central computer
					 installation and resident software are destroyed or damaged;
2. the system interruption or failure
					 resulting from network, operating hardware, software, or operations errors that
					 compromise the integrity of transaction that are active in a live system at the
					 time of the outage; and
3. system
					 interruption or failure resulting from network, operating hardware, software or
					 operations errors that compromise the integrity of data maintained in a live or
					 archival system.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 1 - General Provisions › Chapter 11 - Fiscal Employer Agent Standards for Participation in Home and Community-Based Services Waiver Programs › Subchapter C - Provider Responsibilities › Section XXI-1147 - Fiscal Employer Agent Monitoring

Current through Register Vol. 50, No. 6, June 20, 2024
A. F/EAs
					 shall be monitored on an on-going basis as outlined in the performance
					 agreement.
B. F/EAs shall offer
					 full cooperation with LDH during the monitoring process.
C. Responsibilities of the F/EA in the
					 monitoring process include, but are not limited to, providing policy and
					 procedure manuals, employer/employee records, and other documentation as
					 requested.
D. F/EAs shall cooperate
					 with any audit requests from state or federal agencies.
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 XXI - Home and Community-Based Services Waivers › Subpart 3 - Adult Day Health Care Waiver › Chapter 21 - General Provisions › Section XXI-2101 - Introduction

Current through Register Vol. 50, No. 6, June 20, 2024
A. These standards
				  for participation specify the requirements of the Adult Day Health Care (ADHC)
				  Waiver Program. The program is funded as a waived service under the provisions
				  of Title XIX of the Social Security Act and is administrated by the Department
				  of Health (LDH).
B. Waiver
				  services are provided under the provisions of the approved waiver agreement
				  between the Centers for Medicare and Medicaid Services (CMS) and the Louisiana
				  Medicaid Program.
C. Any provider
				  of services under the ADHC waiver shall abide by and adhere to any federal or
				  state laws, rules, policy, procedures, or manuals issued by the department.
				  Failure to do so may result in sanctions.
D. Each individual who requests ADHC waiver
				  services has the option to designate a responsible representative. For purposes
				  of these provisions, a responsible representative shall be defined as the
				  person designated by the individual to act on his/her behalf in the process of
				  accessing and/or maintaining ADHC waiver services.
1. The appropriate form authorized by the
				  Office of Aging and Adult Services (OAAS) shall be used to designate a
				  responsible representative.
a. The written
				  designation of a responsible representative does not take away the right of the
				  individual to continue to transact business on his/her own behalf nor does it
				  give the representative any legal authority other than as specified in the
				  designation form.
b. The written
				  designation is valid until revoked by the individual granting the designation.
i. To revoke the written designation, the
				  revocation must be submitted in writing to OAAS or its designee.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 3 - Adult Day Health Care Waiver › Chapter 21 - General Provisions › Section XXI-2103 - Program Description

Current through Register Vol. 50, No. 6, June 20, 2024
A. An Adult
				  Day Health Care Waiver Program expands the array of services available to
				  individuals with functional impairments, and helps to bridge the gap between
				  independence and institutional care by allowing them to remain in their own
				  homes and communities. This program provides direct care for individuals who
				  have physical, mental or functional impairments. ADHC waiver participants must
				  attend a minimum of 36 days per calendar quarter, absent extenuating
				  circumstances. Exceptions for extenuating circumstances must be approved by the
				  assigned support coordinator based upon guidance provided by OAAS.
B. The target population for the ADHC Waiver
				  Program includes individuals who:
1. are 65
				  years old or older; or
2. are 22 to
				  64 years old and with a physical disability; and
3. meet nursing facility level of care
				  requirements.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 3 - Adult Day Health Care Waiver › Chapter 21 - General Provisions › Section XXI-2105 - Request for Services Registry [Formerly Section 2107]

Current through Register Vol. 50, No. 6, June 20, 2024
A. The Department of Health is responsible
				  for the Request for Services Registry, hereafter referred to as "the registry",
				  for the ADHC Waiver. An individual who wishes to have his or her name placed on
				  the registry shall contact a toll free telephone number, which shall be
				  maintained by LDH.
B. Individuals
				  who desire their name to be placed on the ADHC waiver registry shall be
				  screened to determine whether they:
1. meet
				  nursing facility level of care; and
2. are members of the target population as
				  identified in the federally-approved waiver document.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 3 - Adult Day Health Care Waiver › Chapter 21 - General Provisions › Section XXI-2107 - Programmatic Allocation of Waiver Opportunities

Current through Register Vol. 50, No. 6, June 20, 2024
A. When funding is appropriated for a new
				  ADHC waiver opportunity or an existing opportunity is vacated, the department
				  shall send a written notice to an individual on the registry indicating that a
				  waiver opportunity is available. That individual shall be evaluated for a
				  possible ADHC waiver opportunity assignment.
B. Adult day health care waiver opportunities
				  shall be offered to individuals on the registry according to priority groups.
				  The following groups shall have priority for ADHC waiver opportunities in the
				  order listed:
1. individuals with
				  substantiated cases of abuse or neglect referred by protective services who,
				  without ADHC waiver services, would require institutional placement to prevent
				  further abuse and neglect;
2.
				  individuals who have been discharged after a hospitalization within the past 30
				  calendar days that involved a stay of at least one night;
3. individuals admitted to, or residing in, a
				  nursing facility who have Medicaid as the sole payer source for the nursing
				  facility stay; and
4. all other
				  eligible individuals on the Request for Services Registry (RFSR), by date of
				  first request for services.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 3 - Adult Day Health Care Waiver › Chapter 23 - Services › Section XXI-2301 - Covered Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				  following services are available to participants in the ADHC Waiver. All
				  services must be provided in accordance with the approved plan of care (POC).
				  No services shall be provided until the POC has been approved.
1. Adult Day Health Care. Services furnished
				  as specified in the POC at a licensed ADHC center, in a non-institutional,
				  community-based setting encompassing both health/medical and social services
				  needed to ensure the optimal functioning of the participant. Services are
				  furnished on a regularly scheduled basis, not to exceed 10 hours a day, 50
				  hours a week. ADHC services include those core service requirements identified
				  in the ADHC licensing standards (LAC 48:I.4243) in addition to:
a. medical care management; and
b. transportation to and from medical and
				  social activities (if the participant is accompanied by the ADHC center staff).
c. - j. Repealed.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 3 - Adult Day Health Care Waiver › Chapter 23 - Services › Section XXI-2303 - Individualized Service Plan

Current through Register Vol. 50, No. 6, June 20, 2024
A. All
				  participants shall have an ADHC individualized service plan (ISP) written in
				  accordance with ADHC licensing standards (LAC 48:I.4281).
1. - 15. Repealed.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 3 - Adult Day Health Care Waiver › Chapter 23 - Services › Section XXI-2305 - Plan of Care

Current through Register Vol. 50, No. 6, June 20, 2024
A.The applicant and
				  support coordinator have the flexibility to construct a plan of care (POC) that
				  serves the participants health, safety and welfare needs. The service package
				  provided under the POC shall include services covered under the Adult Day
				  Health Care Waiver, Medicaid State Plan services, and any other services,
				  regardless of the funding source.
1. All
				  services approved pursuant to the POC shall be medically necessary and provided
				  in a cost-effective manner.
2. The
				  POC shall be developed using a person-centered process coordinated by the
				  support coordinator.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 3 - Adult Day Health Care Waiver › Chapter 25 - Admission and Discharge Criteria › Section XXI-2501 - Admission Criteria

Current through Register Vol. 50, No. 6, June 20, 2024
A. Admission to
				  the ADHC Waiver Program shall be determined in accordance with the following
				  criteria:
1. meets the target population
				  criteria as specified in the approved waiver document;
2. initial and continued Medicaid
				  eligibility;
3. initial and
				  continued eligibility for nursing facility level of care;
4. justification, as documented in the
				  approved POC, that the ADHC waiver services are appropriate, cost-effective and
				  represent the least restrictive environment for the individual; and
5. reasonable assurance that the health,
				  safety and welfare of the individual can be maintained in the community with
				  the provision of ADHC waiver services.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 3 - Adult Day Health Care Waiver › Chapter 25 - Admission and Discharge Criteria › Section XXI-2503 - Admission Denial or Discharge Criteria

Current through Register Vol. 50, No. 6, June 20, 2024
A. Admission shall be denied or the
				  participant shall be discharged from the ADHC Waiver Program if any of the
				  following conditions are determined.
1. The
				  individual does not meet the target population criteria as specified in the
				  federally approved waiver document.
2. The individual does not meet the criteria
				  for Medicaid eligibility.
3. The
				  individual does not meet the criteria for nursing facility level of
				  care.
4. The individual resides in
				  another state or the participant has a change of residence to another
				  state.
5. Continuity of services is
				  interrupted as a result of the participant not receiving and/or refusing ADHC
				  waiver services (exclusive of support coordination services) for a period of 30
				  consecutive days.
a. Exceptions may be
				  granted by OAAS to delay discharge if interruption is due to an acute care
				  hospital, rehabilitation hospital, or nursing facility
				  admission.
6. The health,
				  safety and welfare of the individual cannot be assured through the provision of
				  ADHC waiver services.
7. The
				  individual/participant fails to cooperate in the eligibility determination
				  process, POC development, or in the performance of the POC.
8. It is not cost effective or appropriate to
				  serve the individual in the ADHC Waiver.
9. The participant fails to attend the ADHC
				  center for a minimum of 36 days per calendar quarter.
10. The participant fails to maintain a safe
				  and legal home environment.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 3 - Adult Day Health Care Waiver › Chapter 27 - Provider Responsibilities › Section XXI-2701 - General Provisions

Current through Register Vol. 50, No. 6, June 20, 2024
A. Each
				  ADHC center shall:
1. be licensed by the
				  Department of Health, Health Standards Section, in accordance with LAC 48:I.
				  Chapter 42;
2. enroll as an ADHC
				  Medicaid provider;
3. enter into a
				  provider agreement with the department to provide services; and
4. agree to comply with the provisions of
				  this Rule.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 3 - Adult Day Health Care Waiver › Chapter 27 - Provider Responsibilities › Section XXI-2703 - Reporting Requirements

Current through Register Vol. 50, No. 6, June 20, 2024
A. Support
				  coordinators and direct service providers, including ADHC providers, are
				  obligated to immediately report any changes to the department that could affect
				  the waiver participants eligibility including, but not limited to, those
				  changes cited in the denial or discharge criteria listed in §2503
B. Support coordinators and direct service
				  providers, including ADHC providers, are responsible for documenting the
				  occurrence of incidents or accidents that affect the health, safety and welfare
				  of the participant and completing an incident report. The incident report shall
				  be submitted to the department or its designee with the specified requirements
				  within specified time lines.
C.
				  Support coordinators shall provide the participant's approved POC to the
				  providers listed on the POC in a timely manner.
D. Adult day health care providers shall
				  provide the participants approved individualized service plan to the support
				  coordinator in a timely manner.
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 XXI - Home and Community-Based Services Waivers › Subpart 3 - Adult Day Health Care Waiver › Chapter 27 - Provider Responsibilities › Section XXI-2705 - Electronic Visit Verification (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 XXI - Home and Community-Based Services Waivers › Subpart 3 - Adult Day Health Care Waiver › Chapter 29 - Reimbursement › Section XXI-2901 - Reimbursement and Rate Requirements

Current through Register Vol. 50, No. 6, June 20, 2024
A. Adult day health care services shall be
				  reimbursed according to LAC 50:XXI.709.
1. -
				  5. Repealed.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 3 - Adult Day Health Care Waiver › Chapter 29 - Reimbursement › Section XXI-2903 - Adult Day Health Care (ADHC) Direct Support Worker Wages, Other Benefits, and Workforce Retention Bonus Payments [Formerly LAC 50:XXI.2901]

Current through Register Vol. 50, No. 6, June 20, 2024
A. Establishment of
				  ADHC Direct Support Worker Wage Floor and Other Benefits
1. ADHC providers that were providing ADHC
				  services on or after October 1, 2021 and employing ADHC direct support workers
				  will receive a rate increase. The ADHC reimbursement rates shall be rebased
				  resulting in an average increase of $4.31 per hour (rates differ based on
				  facility specific transportation rate).
2. For direct support workers employed at the
				  ADHC centers on or after October 1, 2021, 70 percent of the ADHC provider rate
				  increases shall be passed directly to the ADHC direct support workers in the
				  form of a minimum wage floor of $9 per hour and in other wage and non-wage
				  benefits.
3. All ADHC providers
				  affected by this rate increase shall be subject to passing 70 percent of their
				  rate increases directly to the ADHC direct support worker 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 ADHC direct support workers of any working status, whether full-time
				  or part-time.
4. The ADHC 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 ADHC direct support worker 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 XXI - Home and Community-Based Services Waivers › Subpart 3 - Adult Day Health Care Waiver › Chapter 29 - Reimbursement › Section XXI-2905 - Cost Categories Included in the Cost Report (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 XXI - Home and Community-Based Services Waivers › Subpart 3 - Adult Day Health Care Waiver › Chapter 29 - Reimbursement › Section XXI-2907 - Allowable Costs (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 XXI - Home and Community-Based Services Waivers › Subpart 3 - Adult Day Health Care Waiver › Chapter 29 - Reimbursement › Section XXI-2909 - Non-allowable Costs (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 XXI - Home and Community-Based Services Waivers › Subpart 3 - Adult Day Health Care Waiver › Chapter 29 - Reimbursement › Section XXI-2911 - Audits (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 XXI - Home and Community-Based Services Waivers › Subpart 3 - Adult Day Health Care Waiver › Chapter 29 - Reimbursement › Section XXI-2913 - Exclusions from the Database (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 XXI - Home and Community-Based Services Waivers › Subpart 3 - Adult Day Health Care Waiver › Chapter 29 - Reimbursement › Section XXI-2915 - Provider 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 XXI - Home and Community-Based Services Waivers › Subpart 5 - Supports Waiver › Chapter 53 - General Provisions › Section XXI-5301 - Purpose

Current through Register Vol. 50, No. 6, June 20, 2024
A. The mission of
				  this waiver is to create options and provide meaningful opportunities that
				  enhance the lives of individuals with intellectual and/or developmental
				  disabilities through employment and day service supports in the community. The
				  goals of the supports waiver are as follows:
1. promote independence for beneficiaries
				  with a developmental disability who are aged 18 years or older while ensuring
				  health and safety through a system of beneficiary safeguards;
2.provide an alternative to
				  institutionalization and costly comprehensive services through the provision of
				  an array of services and supports that promote community inclusion and
				  independence by enhancing and not replacing existing informal networks; and
3.increase high school to community
				  transition resources by offering supports and services to those 18 years and
				  older.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 5 - Supports Waiver › Chapter 53 - General Provisions › Section XXI-5303 - Settings for Home and Community-Based Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. Supports Waiver beneficiaries are expected
				  to be integrated in and have full access to the greater community while
				  receiving services, to the same extent as individuals without disabilities.
				  Providers shall meet the requirements of the U.S. Department of Health and
				  Human Services, Centers for Medicare and Medicaid Services' (CMS) home and
				  community-based setting requirements for home and community-based services
				  (HCBS) waivers as delineated in LAC 50:XXI.901.
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 XXI - Home and Community-Based Services Waivers › Subpart 5 - Supports Waiver › Chapter 55 - Target Population › Section XXI-5501 - Participant Qualifications and Admissions Criteria

Current through Register Vol. 50, No. 6, June 20, 2024
A. In order to qualify for the supports
				  waiver, a beneficiary must be 18 years of age or older, offered a waiver
				  opportunity (slot), and meet all of the following criteria:
1. ...
2. be on the registry, unless otherwise
				  specified through programmatic allocation in §5501;
3. - 4. ...
5. have assurance that the health and welfare
				  of the beneficiary can be maintained in the community with the provision of
				  supports waiver services;
6. have
				  justification, as documentation in the approved plan of care, that supports
				  waiver services are appropriate, cost effective and represent the least
				  restrictive environment for the beneficiary;
7. be a resident of Louisiana; and
8. be a citizen of the United States or a
				  qualified alien.