reglab/statecodes huggingface dataset:
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part VII - Long Term Care › Subpart 3 - Intermediate Care Facilities for Persons with Intellectual Disabilities › Chapter 319 - Utilization Review › Section VII-31901 - Utilization Review

Current through Register Vol. 50, No. 6, June 20, 2024
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 utilization review (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.
					 36:254, Title XIX of the Social Security Act,
					 and 42 CFR
					 456.350 through
					 456.438.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part VII - Long Term Care › Subpart 3 - Intermediate Care Facilities for Persons with Intellectual Disabilities › Chapter 321 - Appeals › Section VII-32101 - Administrative Appeals

Current through Register Vol. 50, No. 6, June 20, 2024
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 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; 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 VII - Long Term Care › Subpart 3 - Intermediate Care Facilities for Persons with Intellectual Disabilities › Chapter 321 - Appeals › Section VII-32103 - Notice and Appeal Procedure

Current through Register Vol. 50, No. 6, June 20, 2024
A. When
				  DHH imposes a sanction on a health care provider, it will give the provider
				  written notice of the imposition. The notice will be given by certified mail
				  and will include the following:
1. the nature
				  of the violation(s) and whether the violation(s) is classified as a repeat
				  violation;
2. the legal authority
				  that established the violation(s);
3. the civil fine assessed for each
				  violation;
4. inform the
				  administrator of the facility that the facility has 10 days from receipt of the
				  notice within which to request an informal reconsideration of proposed
				  sanction;
5. inform the
				  administrator of the facility that the facility has 30 days from receipt of the
				  notice within which to request an administrative appeal of the proposed
				  sanction and that the request for an informal reconsideration does not extend
				  the time limit for requesting an administrative appeal; and
6. inform the administrator of the facility
				  that the consequences of failing to request an informal reconsideration and/or
				  an administrative appeal will be that DHH's decision is final and that no
				  further administrative or judicial review may be had.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part VII - Long Term Care › Subpart 3 - Intermediate Care Facilities for Persons with Intellectual Disabilities › Chapter 321 - Appeals › Section VII-32105 - Collection of Fines

Current through Register Vol. 50, No. 6, June 20, 2024
A. Fines are
				  final when:
1. an appeal is not requested
				  within the specified time limits;
2. the facility admits the violations and
				  agrees to pay the fine; or
3. the
				  administrative hearing affirms DHH's findings of violations and time for
				  seeking judicial review has expired.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part VII - Long Term Care › Subpart 3 - Intermediate Care Facilities for Persons with Intellectual Disabilities › Chapter 323 - Sanctions › Section VII-32301 - Noncompliance

Current through Register Vol. 50, No. 6, June 20, 2024
A. 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 VII - Long Term Care › Subpart 3 - Intermediate Care Facilities for Persons with Intellectual Disabilities › Chapter 323 - Sanctions › Section VII-32303 - Authority

Current through Register Vol. 50, No. 6, June 20, 2024
A.Public Law
				  95-142, dated October 25, 1977, permits the federal government's Health Care
				  Financing Administration (HCFA) to impose a fine and/or imprisonment of
				  facility personnel for illegal admittance and retention practices. HCFA is also
				  authorized to terminate an agreement with a Title XIX ICF/MR provider as a
				  result of deficiencies found during their surveys, which are re-reviews of the
				  state's surveys. Furthermore, the federal government's Office of Inspector
				  General (OIG) is authorized to terminate an agreement with a Title XIX ICF/MR
				  provider for willful misrepresentation of financial facts or for not meeting
				  professionally recognized standards of health care.
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 VII - Long Term Care › Subpart 3 - Intermediate Care Facilities for Persons with Intellectual Disabilities › Chapter 323 - Sanctions › Section VII-32305 - Special Staffing

Current through Register Vol. 50, No. 6, June 20, 2024
A. When the
				  secretary of DHH determines that additional staffing or staff with specific
				  qualifications would be beneficial in correcting deficient practices, DHH may
				  require a facility to hire additional staff on a full-time or consultant basis
				  until the deficient practices have been corrected. This provision may be
				  invoked in concert with, or instead of, the sanctions cited in §32307
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 VII - Long Term Care › Subpart 3 - Intermediate Care Facilities for Persons with Intellectual Disabilities › Chapter 323 - Sanctions › Section VII-32309 - Civil Fines

Current through Register Vol. 50, No. 6, June 20, 2024
A. Louisiana
				  R.S.
				  40:2199 authorized DHH to impose monetary
				  sanctions on those health care facilities found to be out of compliance with
				  any state or federal law or rule concerning the operation and services of the
				  health care provider.
1. Any ICF/MR found to
				  be in violation of any state or federal statute, regulation, or any Department
				  of Health and Hospitals (DHH) rule adopted pursuant to the Act governing the
				  administration and operation of the facility may be sanctioned as provided in
				  the schedule of fines listed under Paragraph 2 below.
a. A
repeat violation
is
				  defined as a violation of a similar nature as a previously cited violation that
				  occurs within 18 months of the previously cited violation. DHH has the
				  authority to determine when a violation is a
repeat
				  violation.
b. The opening
				  or operation of a facility without a license or registration will be a
				  misdemeanor, punishable upon conviction by a fine of not less than $1,000 nor
				  more than $5,000.
i. Each day's violations
				  will constitute a separate offense.
ii. On learning of such an operation, DHH
				  will refer the facility to the appropriate authorities for
				  prosecution.
c. Any
				  ICF/MR found to have a violation that poses a threat to the health, safety,
				  rights, or welfare of a resident or client may be liable for civil fines in
				  addition to any criminal action that may be brought under other applicable
				  laws.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part VII - Long Term Care › Subpart 3 - Intermediate Care Facilities for Persons with Intellectual Disabilities › Chapter 325 - Decertification › Section VII-32501 - Termination of Certification

Current through Register Vol. 50, No. 6, June 20, 2024
A. An
				  ICF/MR may voluntarily or involuntarily lose its participating status in the
				  Medical Assistance Program.
B.
				  Reasons for Decertification of an ICF/MR
1.
				  The ICF/MR may voluntarily withdraw from the program for reasons of its own.
				  The owner and administrator will submit a written notice of withdrawal to the
				  DHH's HSS at least 60 days in advance.
2. A new owner may decide against
				  participation in the program. A written 60-day notice of withdrawal will be
				  submitted to DHH's HSS.
3. DHH may
				  decertify an ICF/MR for failure to comply with Title XIX standards, thus
				  canceling the facility's provider agreement.
4. DHH may decertify an ICF/MR if
				  deficiencies pose immediate jeopardy to the client's health, safety, rights, or
				  welfare.
5. The ICF/MR may allow
				  its provider agreement to expire. A written 60-day advance notice of withdrawal
				  will be submitted to the DHH's HSS.
6. DHH may cancel the provider agreement if
				  and when it is determined that the ICF/MR is in material breach of the
				  contract.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part VII - Long Term Care › Subpart 3 - Intermediate Care Facilities for Persons with Intellectual Disabilities › Chapter 327 - Emergency Awareness › Section VII-32701 - 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 VII - Long Term Care › Subpart 3 - Intermediate Care Facilities for Persons with Intellectual Disabilities › Chapter 329 - Reimbursement Methodology › Subchapter A - Non-State Facilities › Section VII-32901 - Cost Reports

Current through Register Vol. 50, No. 6, June 20, 2024
A. Intermediate
					 care facilities for individuals with intellectual disabilities (ICFs/IID) are
					 required to file annual cost reports to the bureau in accordance with the
					 following instructions.
1. Each ICF/IID 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 VII - Long Term Care › Subpart 3 - Intermediate Care Facilities for Persons with Intellectual Disabilities › Chapter 329 - Reimbursement Methodology › Subchapter A - Non-State Facilities › Section VII-32903 - 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/IID will receive a rate for each resident. The rates are based on cost
					 components appropriate for an economic and efficient ICF/IID 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 ICF/IID.
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. 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;
5. provider fee;
					 and
6. dental pass-through/add-on
					 per diem rate (effective for dates of service on or after May 1,
					 2023).
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part VII - Long Term Care › Subpart 3 - Intermediate Care Facilities for Persons with Intellectual Disabilities › Chapter 329 - Reimbursement Methodology › Subchapter A - Non-State Facilities › Section VII-32904 - Temporary Reimbursement for Private Facilities

Current through Register Vol. 50, No. 6, June 20, 2024
A. The department shall establish temporary
					 Medicaid reimbursement rates of $352.08 per day per individual for a 15-bed
					 private ICF/IID community home and $327.08 for an 8-bed private ICF/IID
					 community home that meet the following criteria. The community home:
1. shall have a fully executed cooperative
					 endeavor agreement (CEA) with the Office for Citizens with Developmental
					 Disabilities for the private operation of the facility;
a. the provider shall be subject to the
					 direct care floor as outlined in the executed CEA;
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part VII - Long Term Care › Subpart 3 - Intermediate Care Facilities for Persons with Intellectual Disabilities › Chapter 329 - Reimbursement Methodology › Subchapter A - Non-State Facilities › Section VII-32905 - ICAP Requirements

Current through Register Vol. 50, No. 6, June 20, 2024
A. An ICAP
					 must be completed for each recipient of ICF/IID services upon admission and
					 while residing in an ICF/IID 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 VII - Long Term Care › Subpart 3 - Intermediate Care Facilities for Persons with Intellectual Disabilities › Chapter 329 - Reimbursement Methodology › Subchapter A - Non-State Facilities › Section VII-32907 - ICAP Monitoring

Current through Register Vol. 50, No. 6, June 20, 2024
A. ICAP
					 scores and assessments will be subject to review by LDH 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.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part VII - Long Term Care › Subpart 3 - Intermediate Care Facilities for Persons with Intellectual Disabilities › Chapter 329 - Reimbursement Methodology › Subchapter A - Non-State Facilities › Section VII-32909 - Audits

Current through Register Vol. 50, No. 6, June 20, 2024
A. Each ICF/IID
					 shall file an annual facility cost report and a central office cost
					 report.
B. ICF/IID shall be subject
					 to financial and compliance audits.
C. All providers who elect to participate in
					 the Medicaid Program shall be subject to audit by state or federal regulators
					 or their designees. Audit selection for the department shall be at the
					 discretion of LDH.
1. A representative sample
					 of the ICF/IID shall be fully audited to ensure the fiscal integrity of the
					 program and compliance of providers with program regulations governing
					 reimbursement.
2. Limited scope and
					 exception audits shall also be conducted as determined by LDH.
3. LDH conducts desk reviews of all the cost
					 reports received. LDH also conducts on-site audits of provider records and cost
					 reports.
a. LDH seeks to maximize the number
					 of on-site audited cost reports available for use in its cost projections
					 although the number of on-site audits performed each year may vary.
b. Whenever possible, the records necessary
					 to verify information submitted to LDH on Medicaid cost reports, including
					 related-party transactions and other business activities engaged in by the
					 provider, must be accessible to LDH audit staff in the state of
					 Louisiana.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part VII - Long Term Care › Subpart 3 - Intermediate Care Facilities for Persons with Intellectual Disabilities › Chapter 329 - Reimbursement Methodology › Subchapter A - Non-State Facilities › Section VII-32911 - Exclusions from Database

Current through Register Vol. 50, No. 6, June 20, 2024
A.
					 Providers with disclaimed audits and providers with cost reports for other than
					 a 12-month period will be excluded from the database used to calculate the
					 rates.
B. Providers who do not
					 submit ICAP scores will be paid at the Intermittent level until receipt of ICAP
					 scores.
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 VII - Long Term Care › Subpart 3 - Intermediate Care Facilities for Persons with Intellectual Disabilities › Chapter 329 - Reimbursement Methodology › Subchapter A - Non-State Facilities › Section VII-32913 - Leave of Absence Days

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
					 reimbursement to non-state ICFs/IID for hospital leave of absence days is 85
					 percent of the applicable per diem rate.
B. The reimbursement for leave of absence
					 days is 100 percent of the applicable per diem rate.
1. A leave of absence is a temporary stay
					 outside of the ICF/IID, for reasons other than for hospitalization, provided
					 for in the recipient's written individual habilitation plan.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part VII - Long Term Care › Subpart 3 - Intermediate Care Facilities for Persons with Intellectual Disabilities › Chapter 329 - Reimbursement Methodology › Subchapter A - Non-State Facilities › Section VII-32915 - Complex Care Reimbursements

Current through Register Vol. 50, No. 6, June 20, 2024
A.
					 Private (non-state) intermediate care facilities for individuals with
					 intellectual disabilities (ICFs/IID) may receive an add-on payment to the per
					 diem rate for providing complex care to Medicaid beneficiaries, when medically
					 necessary. The add-on payment shall be a flat fee daily amount and consists of
					 payment for one of the following components alone or in combination:
1. direct service worker add-on;
2. skilled nursing add-on; and
3. equipment add-on;
4. equipment and DSW;
5. - .7 Repealed.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part VII - Long Term Care › Subpart 3 - Intermediate Care Facilities for Persons with Intellectual Disabilities › Chapter 329 - Reimbursement Methodology › Subchapter A - Non-State Facilities › Section VII-32917 - Dedicated Program Funding Pool Payments

Current through Register Vol. 50, No. 6, June 20, 2024
A. Effective for providers active and
					 Medicaid certified as of September 1, 2019; a one-time lump sum payment will be
					 made to intermediate care facilities for individuals with intellectual
					 disabilities (ICFs/IID).
B.
					 Methodology
1. Payment will be based on each
					 providers specific pro-rated share of an additional dedicated program funding
					 pool totaling $4,665,635.
2. The
					 pro-rated share for each provider will be determined utilizing the providers
					 percentage of total annualized program Medicaid days. Annualized program
					 Medicaid days will be calculated utilizing the most recently desk reviewed or
					 audited cost reports as of July 1, 2019.
3. The additional dedicated program funding
					 pool lump sum payments shall not exceed the Medicare upper payment limit in the
					 aggregate for the provider class.
4. The one-time payment will be made on or
					 before June 30, 2020.
5. Payment of
					 the one-time lump sum payment is subject to approval by the U.S. Department of
					 Health and Human Services, Centers for Medicaid and Medicare Services
					 (CMS).
C. Effective for providers
					 active and Medicaid certified as of July 1, 2022, a one-time, lump sum payment
					 will be made to non-state, non-public intermediate care facilities for
					 individuals with intellectual disabilities (ICFs/IID).
1. Methodology
a. Payment will be based on each provider's
					 specific pro-rated share of an additional dedicated program funding pool
					 totaling $27,974,178.
b. The
					 pro-rated share for each provider will be determined utilizing the provider's
					 percentage of program Medicaid days for dates of service in a three consecutive
					 month period selected by the department occurring between January 1, 2022 and
					 December 31, 2022.
c. If the
					 additional dedicated program funding pool lump sum payments exceed the Medicare
					 upper payment limit in the aggregate for the provider class, the department
					 shall recoup the overage using the same means of distribution in
					 §
															32917.C.1.b
					 above.
d. The one-time payment will
					 be made on or before June 30, 2023.
e. All facilities receiving payment shall be
					 open and operating as an ICF/IID at the time the payment is made.
f. Payment of the one-time, lump sum payment
					 is subject to approval by the U.S. Department of Health and Human Services,
					 Centers for Medicare and Medicaid Services (CMS).
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part VII - Long Term Care › Subpart 3 - Intermediate Care Facilities for Persons with Intellectual Disabilities › Chapter 329 - Reimbursement Methodology › Subchapter B - Qualifying Loss Review (Private Facilities) (Repealed) › Section VII-32949 - Basis for Administrative Review (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 VII - Long Term Care › Subpart 3 - Intermediate Care Facilities for Persons with Intellectual Disabilities › Chapter 329 - Reimbursement Methodology › Subchapter B - Qualifying Loss Review (Private Facilities) (Repealed) › Section VII-32951 - Request for Administrative Review (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 VII - Long Term Care › Subpart 3 - Intermediate Care Facilities for Persons with Intellectual Disabilities › Chapter 329 - Reimbursement Methodology › Subchapter B - Qualifying Loss Review (Private Facilities) (Repealed) › Section VII-32953 - Basis for Rate Adjustment (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 VII - Long Term Care › Subpart 3 - Intermediate Care Facilities for Persons with Intellectual Disabilities › Chapter 329 - Reimbursement Methodology › Subchapter B - Qualifying Loss Review (Private Facilities) (Repealed) › Section VII-32955 - Awarding Relief (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 VII - Long Term Care › Subpart 3 - Intermediate Care Facilities for Persons with Intellectual Disabilities › Chapter 329 - Reimbursement Methodology › Subchapter C - Public Facilities › Section VII-32965 - State-Owned and Operated Facilities

Current through Register Vol. 50, No. 6, June 20, 2024
A. Medicaid payments to state-owned and
					 operated intermediate care facilities for persons with developmental
					 disabilities are based on the Medicare formula for determining the routine
					 service cost limits as follows:
1. calculate
					 each state-owned and operated ICF/IID's per diem routine costs in a base
					 year;
2. calculate 112 percent of
					 the average per diem routine costs; and
3. inflate 112 percent of the per diem
					 routine costs using the skilled nursing facility (SNF) market basket index of
					 inflation.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part VII - Long Term Care › Subpart 3 - Intermediate Care Facilities for Persons with Intellectual Disabilities › Chapter 329 - Reimbursement Methodology › Subchapter C - Public Facilities › Section VII-32967 - Quasi-Public Facilities

Current through Register Vol. 50, No. 6, June 20, 2024
A. Medicaid
					 payment to quasi-public facilities is a facility-specific prospective rate
					 based on budgeted costs. Providers shall be required to submit a projected
					 budget for the state fiscal year beginning July 1.
B. The payment rates for quasi-public
					 facilities shall be determined as follows:
1.
					 determine each ICF/IID's per diem for the base year beginning July 1;
2. calculate the inflation factor using an
					 average CPI index applied to each facility's per diem for the base year to
					 determine the inflated per diem;
3.
					 calculate the median per diem for the facilities' base year;
4. calculate the facility's routine cost per
					 diem for the SFY beginning July 1 by using the lowest of the budgeted, inflated
					 or median per diem rates plus any additional allowances; and
5. calculate the final approved per diem rate
					 for each facility by adding routine costs plus any "pass through" amounts for
					 ancillary services, provider fees, and grant expenses.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part VII - Long Term Care › Subpart 3 - Intermediate Care Facilities for Persons with Intellectual Disabilities › Chapter 329 - Reimbursement Methodology › Subchapter C - Public Facilities › Section VII-32969 - Transitional Rates for Public Facilities

Current through Register Vol. 50, No. 6, June 20, 2024
A. Effective October 1, 2012, the department
					 shall establish a transitional Medicaid reimbursement rate of $302.08 per day
					 per individual for a public ICF/IID facility over 50 beds that is transitioning
					 to a private provider, as long as the provider meets the following criteria:
1. shall have a fully executed cooperative
					 endeavor agreement (CEA) with the Office for Citizens with Developmental
					 Disabilities (OCDD) for the private operation of the facility;
2. shall have a high concentration of
					 medically fragile individuals being served, as determined by the department;
a. for purposes of these provisions, a
					 medically fragile individual shall refer to an individual who has a medically
					 complex condition characterized by multiple, significant medical problems that
					 require extended care;
3. incurs or will incur higher existing costs
					 not currently captured in the private ICF/IID rate methodology; and
4. shall agree to downsizing and implement a
					 pre-approved OCDD plan:
a. any ICF/IID home
					 that is a cooperative endeavor agreement (CEA) to which individuals transition
					 to satisfy downsizing requirements, shall not exceed 6-8 beds.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part VII - Long Term Care › Subpart 3 - Intermediate Care Facilities for Persons with Intellectual Disabilities › Chapter 331 - Vendor Payments › Section VII-33101 - Income Consideration in Determining Payment

Current through Register Vol. 50, No. 6, June 20, 2024
A. 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.
1. 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.
2. 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.
3. 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 VII - Long Term Care › Subpart 3 - Intermediate Care Facilities for Persons with Intellectual Disabilities › Chapter 331 - Vendor Payments › Section VII-33105 - Evacuation and Temporary Sheltering Costs

Current through Register Vol. 50, No. 6, June 20, 2024
A. Intermediate care facilities for persons
				  with intellectual disabilities required to participate in an evacuation, as
				  directed by the appropriate parish or state official, or which act as a host
				  shelter site may be entitled to reimbursement of its documented and allowable
				  evacuation and temporary sheltering costs.
1.
				  The expense incurred must be in excess of any existing or anticipated
				  reimbursement from any other sources, including the Federal Emergency
				  Management Agency (FEMA) or its successor.
2. ICFs/ID must first apply for evacuation or
				  sheltering reimbursement from all other sources and request that the department
				  apply for FEMA assistance on their behalf.
3. ICFs/ID must submit expense and
				  reimbursement documentation directly related to the evacuation or temporary
				  sheltering of Medicaid residents to the department.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part IX - Professional Services Program › Subpart 1 - General Provisions › Chapter 3 - Concurrent Care › Section IX-305 - Inpatient Concurrent Care (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 IX - Professional Services Program › Subpart 1 - General Provisions › Chapter 5 - Inpatient Physician Services › Section IX-501 - Inpatient Physician Services (Repealed)

Current through Register Vol. 50, No. 6, June 20, 2024
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 36:254 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part IX - Professional Services Program › Subpart 1 - General Provisions › Chapter 6 - Outpatient Physician Services › Section IX-601 - General Provisions

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				  Medicaid Program provides coverage and reimbursement for outpatient physician
				  visits. There shall be no limits placed on the number of physician visits
				  payable by the Medicaid Program for eligible beneficiaries.
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 IX - Professional Services Program › Subpart 1 - General Provisions › Chapter 7 - Diabetes Education Services › Section IX-701 - General Provisions

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Effective for dates of service on or after February 20, 2011, the Medicaid
				  Program provides coverage of diabetes self-management training (DSMT) services
				  rendered to Medicaid beneficiaries diagnosed with diabetes mellitus.
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 IX - Professional Services Program › Subpart 1 - General Provisions › Chapter 7 - Diabetes Education Services › Section IX-703 - Scope of Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. DSMT shall
				  consist of individual and group instruction on diabetes
				  self-management.
B.
				  Repealed.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 36:254 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part IX - Professional Services Program › Subpart 1 - General Provisions › Chapter 7 - Diabetes Education Services › Section IX-705 - Provider Participation

Current through Register Vol. 50, No. 6, June 20, 2024
A. To
				  receive reimbursement, members of the DSMT instructional team must be either
				  employed by or have a contract with, a Medicaid-enrolled professional services
				  provider that will submit the claims for reimbursement of DSMT services
				  rendered by the team.
1. - C.
				  Repealed.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part IX - Professional Services Program › Subpart 1 - General Provisions › Chapter 9 - Fluoride Varnish Application Services › Section IX-901 - General Provisions

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Effective for dates of service on or after December 1, 2011, the Medicaid
				  Program provides coverage of fluoride varnish application services to
				  beneficiaries under the age of 21.
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 IX - Professional Services Program › Subpart 1 - General Provisions › Chapter 9 - Fluoride Varnish Application Services › Section IX-903 - Scope of Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. Fluoride
				  varnish application services performed in a physician office setting shall be
				  reimbursed by the Medicaid Program when rendered by the appropriate
				  professional services providers.
B.
				  Repealed.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 36:254 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part IX - Professional Services Program › Subpart 1 - General Provisions › Chapter 9 - Fluoride Varnish Application Services › Section IX-905 - Provider Participation

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				  entity seeking reimbursement for fluoride varnish application services must be
				  an enrolled Medicaid provider.
1. - C.2.
				  Repealed.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part IX - Professional Services Program › Subpart 1 - General Provisions › Chapter 11 - Tobacco Cessation Counseling Services › Section IX-1101 - General Provisions

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Effective for dates of service on or after June 20, 2023, the Medicaid Program
				  provides coverage for tobacco cessation counseling services to beneficiaries
				  who use tobacco products or who are being treated for tobacco use.
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 IX - Professional Services Program › Subpart 1 - General Provisions › Chapter 11 - Tobacco Cessation Counseling Services › Section IX-1103 - Scope of Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. Tobacco
				  cessation counseling services shall be reimbursed by the Medicaid Program when
				  rendered by the beneficiary's primary care provider (PCP) or other appropriate
				  healthcare professionals. Beneficiaries may receive up to four tobacco
				  cessation counseling sessions per quit attempt, up to two quit attempts per
				  calendar year, for a maximum of eight counseling sessions per calendar year.
				  These limits may be exceeded, if deemed medically necessary.
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 IX - Professional Services Program › Subpart 1 - General Provisions › Chapter 11 - Tobacco Cessation Counseling Services › Section IX-1105 - Provider Participation

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				  entity seeking reimbursement for tobacco cessation counseling services must be
				  an enrolled Medicaid provider.
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 IX - Professional Services Program › Subpart 1 - General Provisions › Chapter 13 - Physician Directed Treatment-In-Place Ambulance Services › Section IX-1301 - General Provisions

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Effective for dates of service on or after May 12, 2023, the Louisiana Medicaid
				  Program provides coverage for initiation and facilitation of telehealth
				  services by qualified Louisiana Medicaid enrolled ambulance
				  providers.
B. Ambulance providers
				  interested in offering physician directed treatment-in-place telehealth
				  services must complete the following:
1.
				  enroll as a CMS ET3 model participant;
2. enter into a partnership with a qualified,
				  Louisiana Medicaid enrolled healthcare provider to furnish treatment-in-place
				  telehealth services to Louisiana Medicaid beneficiaries; and
3. notify the Department of Health of its
				  partnerships with each telehealth provider.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part IX - Professional Services Program › Subpart 1 - General Provisions › Chapter 13 - Physician Directed Treatment-In-Place Ambulance Services › Section IX-1303 - Scope of Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. Initiation
				  and facilitation of physician directed treatment-in-place telehealth services
				  are performed by Louisiana Medicaid enrolled ambulance providers on site, with
				  no transport, using audio and video telecommunications systems that permit
				  real-time communication between a qualified, Medicaid enrolled, licensed
				  medical practitioner and the beneficiary.
B. All services provided by ambulance
				  providers during the initiation and facilitation of the physician directed
				  treatment-in-place intervention are covered by the associated BLS-E, emergency
				  base rate, or the ALS1-E, Level 1 emergency base rate.
C. Ambulance providers are not eligible to
				  submit a claim for reimbursement or receive payment for other services (except
				  for supplies) at the scene.
D. If a
				  beneficiary must be transported to an emergency department (ED) due to poor
				  internet connection, which resulted in a failed physician directed
				  treatment-in-place encounter, or the beneficiary's condition deteriorates, the
				  ambulance provider may submit a claim for reimbursement and receive
				  compensation for the transport to the ED, but not for initiation and
				  facilitation of the telehealth service.
E. The entity seeking reimbursement for the
				  corresponding physician directed treatment-in-place telehealth service must be
				  an enrolled Louisiana Medicaid provider.
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 IX - Professional Services Program › Subpart 1 - General Provisions › Chapter 13 - Physician Directed Treatment-In-Place Ambulance Services › Section IX-1305 - Reimbursement

Current through Register Vol. 50, No. 6, June 20, 2024
A. Reimbursement to
				  the ambulance providers for initiation and facilitation of the physician
				  directed treatment-in-place telehealth service requires a corresponding
				  treatment-in-place telehealth service. The corresponding treatment-in-place
				  telehealth service is demonstrated via a Louisiana Medicaid paid
				  treatment-in-place telehealth service claim.
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 IX - Professional Services Program › Subpart 7 - Immunizations › Chapter 83 - Children's Immunizations › Section IX-8301 - General Provisions

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				  Medicaid Program shall provide coverage for the administration of childhood and
				  adolescent vaccines recommended by the Advisory Committee on Immunization
				  Practices and available through the Louisiana Immunization Program/Vaccines for
				  Children Program.
B. To qualify for
				  Medicaid reimbursement for vaccine administration, a provider must be:
1. a licensed health care provider who has
				  the authority under Louisiana state law to administer childhood and adolescent
				  vaccines;
2. an enrolled Medicaid
				  provider; and
3. an enrolled
				  Louisiana Immunization Program/Vaccines for Children Program
				  provider.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part IX - Professional Services Program › Subpart 7 - Immunizations › Chapter 83 - Children's Immunizations › Section IX-8305 - Reimbursement Methodology

Current through Register Vol. 50, No. 6, June 20, 2024
A. There
				  shall be no reimbursement for the cost of vaccines that are available from the
				  Louisiana Immunization Program/Vaccines for Children Program.
1. Repealed.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part IX - Professional Services Program › Subpart 7 - Immunizations › Chapter 85 - Adult Immunizations › Section IX-8501 - General Provisions

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				  Medicaid Program shall provide coverage for vaccines recommended by the
				  Advisory Committee on Immunization Practices for beneficiaries age 19 and
				  older.
1. - 3. Repealed.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part IX - Professional Services Program › Subpart 7 - Immunizations › Chapter 85 - Adult Immunizations › Section IX-8503 - Coverage Restrictions (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 IX - Professional Services Program › Subpart 7 - Immunizations › Chapter 85 - Adult Immunizations › Section IX-8505 - Reimbursement Methodology

Current through Register Vol. 50, No. 6, June 20, 2024
A. For the
				  vaccine and vaccine administration, providers shall be reimbursed according to
				  the established fee schedule or billed charges, whichever is the lesser
				  amount.
B. The reimbursement
				  methodology for the vaccine is as a physician-administered drug under the
				  provisions of LAC 50:XXIX.949.
1. - B.3.a.
				  Repealed.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part IX - Professional Services Program › Subpart 15 - Reimbursement › Chapter 151 - Reimbursement Methodology › Subchapter A - General Provisions › Section IX-15101 - Enhanced Federal Medical Assistance Percentage Rate for Preventive Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. Effective for
					 dates of service on or after May 15, 2017, the federal medical assistance
					 percentage (FMAP) rate received by the department for specified adult vaccines
					 and clinical preventive services shall increase one percentage point of the
					 rate on file as of May 14, 2017.
1. Services
					 covered by this increase are those assigned a grade of A or B by the United
					 States Preventive Services Task Force (USPSTF) and approved vaccines and their
					 administration as recommended by the Advisory Committee on Immunization
					 Practices (ACIP).
2. The increased
					 FMAP rate applies to these qualifying services whether the services are
					 provided on a fee-for-service (FFS) or managed care basis.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part IX - Professional Services Program › Subpart 15 - Reimbursement › Chapter 151 - Reimbursement Methodology › Subchapter A - General Provisions › Section IX-15103 - Diabetes Education Services

Current through Register Vol. 50, No. 6, June 20, 2024
A.
					 Effective for dates of service on or after February 20, 2011, the Medicaid
					 Program shall provide reimbursement for diabetes self-management training
					 services rendered by qualified health care professionals.
B. Reimbursement for DSMT services shall be a
					 flat fee based on the appropriate healthcare common procedure coding (HCPC)
					 code.
AUTHORITY NOTE:
						Promulgated in accordance with
						R.S.
						36:254 and Title XIX of the Social Security
						Act.