reglab/statecodes huggingface dataset:
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 13 - Residential Options Waiver › Chapter 161 - General Provisions › Section XXI-16106 - Money Follows the Person Rebalancing Demonstration

Current through Register Vol. 50, No. 6, June 20, 2024
A. The Money Follows the Person (MFP)
				  Rebalancing Demonstration is a federal demonstration grant awarded by the
				  Centers for Medicare and Medicaid Services to the Department of Health. The MFP
				  demonstration is a transition program that targets individuals using qualified
				  institutional services and moves them to home and community-based long-term
				  care services. The MFP rebalancing demonstration will stop allocation of
				  opportunities when the demonstration expires.
1. For the purposes of these provisions, a
				  qualified institution is a nursing facility, hospital, or Medicaid enrolled
				  intermediate care facility for individuals with intellectual disabilities
				  (ICF/IID).
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 13 - Residential Options Waiver › Chapter 161 - General Provisions › Section XXI-16107 - Programmatic Allocation of Waiver Opportunities

Current through Register Vol. 50, No. 6, June 20, 2024
A. The intellectual/developmental
				  disabilities request for services registry, hereafter referred to as "the
				  registry," shall be used to identify individuals with intellectual and/or
				  developmental disabilities who are waiting for an OCDD waiver opportunity.
				  Individuals who are found eligible for developmental disabilities services
				  using standardized tools, and who request waiver services will be added to the
				  registry. The request for services registry (RFSR) is arranged by urgency of
				  need and date of application for developmentally disabled (DD) waiver
				  services.
B. The ROW serves
				  eligible individuals in the following populations and is based on the following
				  priorities:
1. Priority 1. The one-time
				  transition of persons eligible for developmental disability (DD) services in
				  either OAAS Community Choices Waiver (CCW) or OAAS Adult Day Health Care (ADHC)
				  Waiver to the ROW.
2. Priority 2.
				  Individuals living at Pinecrest Supports and Services Center or in a publicly
				  operated ICF/IID when it was transitioned to a private ICF/IID through a
				  cooperative endeavor agreement (CEA facility), or their alternates. Alternates
				  are defined as individuals living in a private ICF/IID who will give up the
				  private ICF/IID bed to an individual living at Pinecrest or to an individual
				  who was living in a publicly operated ICF/IID when it was transitioned to a
				  private ICF/IID through a cooperative endeavor agreement. Individuals
				  requesting to transition from Pinecrest are awarded a slot when one is
				  requested and their health and safety can be assured in an OCDD waiver. This
				  also applies to individuals who were residing in a state operated facility at
				  the time the facility was privatized and became a CEA facility.
3. Priority 3. Individuals on the registry
				  who have the highest level of need and the earliest registry date shall be
				  notified in writing when a funded OCDD waiver opportunity is available and that
				  he/she is next in line to be evaluated for a possible waiver assignment, and
				  the ROW shall have justification based on a uniform needs-based assessment and
				  a person-centered planning that the ROW is the OCDD waiver that will best meet
				  the needs of the individual.
4.
				  Priority 4. Individuals transitioning from ICF/IID facilities utilizing ROW
				  conversion.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 13 - Residential Options Waiver › Chapter 161 - General Provisions › Section XXI-16109 - Admission Denial or Discharge Criteria

Current through Register Vol. 50, No. 6, June 20, 2024
A. Admission to the ROW Program shall be
				  denied if one of the following criteria is met.
1. The individual does not meet the financial
				  eligibility requirements for the Medicaid Program.
2. The individual does not meet the
				  requirements for an ICF/IID level of care.
3. The individual does not meet developmental
				  disability system eligibility.
4.
				  The individual is incarcerated or under the jurisdiction of penal authorities,
				  courts or state juvenile authorities.
5. The individual resides in another
				  state.
6. The health and welfare of
				  the individual cannot be assured through the provision of ROW
				  services.
7. The individual fails
				  to cooperate in the eligibility determination process or in the development of
				  the POC.
8. The individual does not
				  have justification, based on a uniform needs-based assessment and a
				  person-centered planning discussion that the ROW is the OCDD waiver that will
				  meet the needs of the individual.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 13 - Residential Options Waiver › Chapter 163 - Covered Services › Section XXI-16301 - Assistive Technology and Specialized Medical Equipment and Supplies

Current through Register Vol. 50, No. 6, June 20, 2024
A. Assistive
				  technology and specialized medical equipment and supplies (AT/SMES) service
				  includes providing specialized devices, controls, or appliances which enable a
				  beneficiary to increase his/her ability to perform activities of daily living,
				  ensure safety, and/or to perceive, control, and communicate within his/her
				  environment.
1. This service also includes
				  items that meet at least one of the following criteria:
a. items that are necessary for life
				  support;
b. items that are
				  necessary to address physical conditions, along with ancillary
				  supplies;
c. address physical
				  conditions;
d. items that will
				  increase, maintain, or improve ability of the beneficiary to function more
				  independently in the home and/or community; and
e. equipment necessary to the proper
				  functioning of such items.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 13 - Residential Options Waiver › Chapter 163 - Covered Services › Section XXI-16303 - Community Living Supports

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Community living supports (CLS) are provided to a beneficiary in his/her own
				  home and in the community to achieve and/or to maintain the outcomes of
				  increased independence, productivity, and enhanced family functioning, to
				  provide relief of the caregiver, and to provide for inclusion in the community.
				  Community living supports may be a self-directed service.
B. Community living supports focus on the
				  achievement of one or more goals as indicated in the beneficiary's approved
				  plan of care by incorporating teaching and support strategies. Supports
				  provided are related to the acquisition, improvement, and maintenance of
				  independence, autonomy and adaptive skills. These skills include:
1. self-help skills;
2. socialization skills;
3. cognitive and communication skills;
				  and
4. development of appropriate,
				  positive behaviors.
a. - b.
				  Repealed.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 13 - Residential Options Waiver › Chapter 163 - Covered Services › Section XXI-16305 - Companion Care

Current through Register Vol. 50, No. 6, June 20, 2024
A. Companion care
				  services provide supports to assist the beneficiary in achieving and/or
				  maintaining increased independence, productivity and community inclusion as
				  identified in the beneficiary's plan of care. These services are designed for
				  individuals who live independently and can manage their own household with
				  limited supports. The companion provides personal care and supportive services
				  to a beneficiary who resides as a roommate with his/her caregiver. This service
				  includes:
1. providing assistance with all of
				  the activities of daily living as indicated in the beneficiary's POC;
				  and
2. community integration and
				  coordination of transportation services, including medical
				  appointments.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 13 - Residential Options Waiver › Chapter 163 - Covered Services › Section XXI-16307 - Day Habilitation Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. Day habilitation is services that assist
				  the beneficiary to gain desired community living experience, including the
				  acquisition, retention, or improvement in self-help, socialization, and
				  adaptive skills, and/or to provide the beneficiary an opportunity to contribute
				  to his or her community. These services shall be coordinated with any physical,
				  occupational, or speech therapies identified in the individualized plan of
				  care. Day habilitation services may include assistance with personal care or
				  with activities of daily living, but such assistance should not be the primary
				  activity. Day habilitation services may serve to reinforce skills or lessons
				  taught in other settings. Volunteer activities may be a part of this service
				  and should follow the state guidelines for volunteering.
1. - 3. Repealed.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 13 - Residential Options Waiver › Chapter 163 - Covered Services › Section XXI-16309 - Dental Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. Dental
				  services are available to adult beneficiaries over the age of 21 as of
				  component of the ROW. Covered dental services include:
1. adult diagnostic services;
2. preventative services;
3. restorative services;
4. endodontics;
5. periodontics;
6. prosthodontics;
7. oral and maxillofacial surgery;
8. orthodontics;
9. emergency care; and
10. adjunctive general services.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 13 - Residential Options Waiver › Chapter 163 - Covered Services › Section XXI-16311 - Environmental Accessibility Adaptations

Current through Register Vol. 50, No. 6, June 20, 2024
A. Environmental accessibility adaptations
				  are physical adaptations to the beneficiary's home or vehicle which are
				  necessary to ensure health, welfare, and safety of the beneficiary, or which
				  enable the beneficiary to function with greater independence, without which the
				  beneficiary would require additional supports or institutionalization.
				  Environmental adaptations must be specified in the beneficiary's plan of care.
1. Reimbursement shall not be paid until
				  receipt of written documentation that the job has been completed to the
				  satisfaction of the beneficiary.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 13 - Residential Options Waiver › Chapter 163 - Covered Services › Section XXI-16313 - Host Home

Current through Register Vol. 50, No. 6, June 20, 2024
A. Host home
				  services are personal care and supportive services provided to a beneficiary
				  who lives in a private home with a family who is not the beneficiary's parent,
				  legal representative, or spouse. Host home families are a standalone family
				  living arrangement in which the principle caregiver in the host home assumes
				  the direct responsibility for the beneficiary's physical, social, and emotional
				  wellbeing and growth in a family environment. Host home services are to take
				  into account compatibility with the host home family members, including age,
				  support needs, and privacy needs.
B. Host home services include assistance
				  with:
1. personal care, assistance with the
				  activities of daily living and adaptive living needs;
2. leisure activities, assistance to develop
				  leisure interests and daily activities in the home setting;
3. social development/family inclusion,
				  assistance to develop relationships with other members of the household;
				  and
4. community inclusion supports
				  in accessing community services and activities and pursuing and developing
				  recreational and social interests outside the home.
NOTE: Natural supports are also encouraged and supported
					 when possible. Supports are to be consistent with the beneficiary's skill
					 level, goals, and interests.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 13 - Residential Options Waiver › Chapter 163 - Covered Services › Section XXI-16315 - Intensive Community Supports (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 13 - Residential Options Waiver › Chapter 163 - Covered Services › Section XXI-16317 - Nursing Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. Nursing
				  services are medically necessary services ordered by a physician and provided
				  by a licensed registered nurse or a licensed practical nurse under the
				  supervision of a registered nurse, within the scope of the State's Nurse
				  Practice Act. Nursing services provided in the ROW are an extension of nursing
				  services provided through the Home Health Program covered under the Medicaid
				  State Plan.
1. Nursing services must be
				  included in the beneficiary's plan of care and must have the following:
a. physician's order,
b. physician's letter of medical
				  necessity,
c. Form 90-L,
d. Form 485,
e. individual nursing service plan,
f. summary of medical history, and
g. skilled nursing checklist.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 13 - Residential Options Waiver › Chapter 163 - Covered Services › Section XXI-16319 - One Time Transitional Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. One-time transitional services are
				  non-reoccurring set-up expenses to assist a beneficiary who is moving from an
				  institutional setting to his or her own home. The beneficiary's support
				  coordinator assists in accessing funds and making arrangements in preparation
				  for moving into the residence.
B.
				  One-time transitional services may be accessed for the following:
1. non-refundable security deposit;
2. utility deposits (set-up/deposit fee for
				  telephone service);
3. essential
				  furnishings to establish basic living arrangements, including:
a. bedroom furniture;
b. living room furniture;
c. tables and chairs;
d. window blinds; and
e. kitchen items (i.e., food preparation
				  items, eating utensils, etc.);
4. moving expenses; and
5. health and safety assurances (i.e., pest
				  eradication, one-time cleaning prior to occupancy, etc.).
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 13 - Residential Options Waiver › Chapter 163 - Covered Services › Section XXI-16321 - Personal Emergency Response System (PERS)

Current through Register Vol. 50, No. 6, June 20, 2024
A. Personal emergency response system (PERS)
				  service is an electronic device connected to the beneficiary's phone that
				  enables him or her to secure help in an emergency. The service also includes an
				  option in which the beneficiary would wear a portable help button. The device
				  is programmed to emit a signal to the PERS response center where trained
				  professionals respond to the beneficiary's emergency situation.
B.Beneficiary Qualifications. PERS service is
				  most appropriate for beneficiaries who:
1. are
				  able to identify when they are in an emergency situation and then able to
				  activate the system requesting assistance; and
2. are unable to summon assistance by dialing
				  911 or other emergency services available to the general public.
3. Repealed.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 13 - Residential Options Waiver › Chapter 163 - Covered Services › Section XXI-16323 - Prevocational Services

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Prevocational services are individualized, person centered services that assist
				  beneficiaries in establishing their path to obtain individualized community
				  employment. This service is time limited and targeted for people who have an
				  interest in becoming employed in individual jobs in the community but who may
				  need additional skills, information, and experiences to determine their
				  employment goal and to become successfully employed. Beneficiaries receiving
				  prevocational services may choose to leave this service at any time or pursue
				  employment opportunities at any time.
B. Prevocational services should be offered
				  that engage workers in real and simulated employment tasks to determine
				  vocational potential. Services focus on teaching concepts and skills, such as
				  following directions, attending to tasks, task completion, problem solving, and
				  job safety skills. All prevocational services are to be reflective of the
				  participant's plan of care and directed toward habilitation rather than
				  teaching a specific job skill.
1. onsite
				  prevocational services;
2.
				  community career planning; and
3.
				  virtual prevocational services.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 13 - Residential Options Waiver › Chapter 163 - Covered Services › Section XXI-16325 - Professional Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. Professional
				  services are direct services to beneficiaries based on the beneficiary's need,
				  which assist the beneficiary, unpaid caregivers, and/or paid caregivers in
				  carrying out the beneficiary's approved plan and which are necessary to improve
				  the beneficiary's independence and inclusion in his/her community. The
				  beneficiary must be present in order for the professional to bill for services.
				  Professional services include nutritional services, speech therapy,
				  occupational therapy, physical therapy, social work, and psychological
				  services. All services are to be included in the beneficiary's plan of care.
				  The specific service provided to a beneficiary must be within the
				  professional's area of specialty and licensing.
B. Professional services include services
				  provided by the following licensed professionals:
1. occupational therapists;
2. physical therapists;
3. speech therapists;
4. registered dieticians;
5. social workers; and
6. psychologists.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 13 - Residential Options Waiver › Chapter 163 - Covered Services › Section XXI-16327 - Respite Care Services-Out of Home

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Respite care services-out of home are provided on a short-term basis to
				  beneficiaries who are unable to care for themselves due to the absence of, or
				  need for, relief of caregivers who normally provide care and support. Services
				  are provided by a center-based respite provider.
1. A licensed respite care facility shall
				  insure that community activities are available to the beneficiary in accordance
				  with his approved POC, including transportation to and from these
				  activities.
2. While receiving
				  respite care services, the beneficiary's routine is maintained in order to
				  attend school, school activities or other community activities. Community
				  activities and transportation to and from these activities in which the
				  beneficiary typically engages in are to be available while receiving respite
				  services-out of home.
a. These activities
				  should be included in the beneficiary's approved plan of care. This will
				  provide the beneficiary the opportunity to continue to participate in typical
				  routine activities.
b.
				  ...
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 13 - Residential Options Waiver › Chapter 163 - Covered Services › Section XXI-16329 - Shared Living Services

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Shared living services are provided to a beneficiary in his/her home and
				  community to achieve, improve, and/or maintain social and adaptive skills
				  necessary to enable the beneficiary to reside in the community and to
				  participate as independently as possible. Services are chosen by the
				  beneficiary and developed in accordance with his/her goals and wishes with
				  regard to compatibility, interests, age and privacy in the shared living
				  setting.
1. A shared living services provider
				  delivers supports which include:
a. 24-hour
				  staff availability;
b. assistance
				  with activities of daily living included in the beneficiary's POC;
c. a daily schedule;
d. health and welfare needs;
e. transportation;
f. any non-residential ROW services delivered
				  by the shared living services provider; and
g. other responsibilities as required in each
				  beneficiary's POC.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 13 - Residential Options Waiver › Chapter 163 - Covered Services › Section XXI-16331 - Specialized Medical Equipment and Supplies (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 13 - Residential Options Waiver › Chapter 163 - Covered Services › Section XXI-16333 - Support Coordination

Current through Register Vol. 50, No. 6, June 20, 2024
A. Support
				  coordination services are provided to all beneficiaries to provide assistance
				  in gaining access to needed waiver services and Medicaid State Plan services,
				  as well as needed medical, social, education, and other services, regardless of
				  the funding source for the services. Support coordination services include
				  assistance with the selection of service providers, development/revision of the
				  plan of care, and monitoring of services.
1.
				  Support coordinators shall be responsible for ongoing monitoring of the
				  provision of services included in the beneficiary's approved POC.
2. Support coordinators shall also
				  participate in the evaluation and re-evaluation of the beneficiary's
				  POC.
3. Support coordination
				  services includes on-going support and assistance to the beneficiary.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 13 - Residential Options Waiver › Chapter 163 - Covered Services › Section XXI-16335 - Supported Employment

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Supported employment services consist of intensive, ongoing supports and
				  services necessary for a beneficiary to achieve the desired outcome of
				  employment in a community setting where a majority of the persons employed are
				  without disabilities. Beneficiaries utilizing these services may need long-term
				  supports for the life of their employment due to the nature of their
				  disability, and natural supports may not meet this need.
B. Supported employment services provide
				  supports in the following areas:
1. individual
				  job placement, group employment, or self-employment;
2. job assessment, discovery, and
				  development; and
3. initial job
				  support and job retention.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 13 - Residential Options Waiver › Chapter 163 - Covered Services › Section XXI-16337 - Transportation-Community Access

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Transportation-community access services are provided to assist the beneficiary
				  in becoming involved in his or her community. The service encourages and
				  fosters the developmental of meaningful relationships in the community which
				  reflects the beneficiary's choice and values. This service provides the
				  beneficiary with a means of access to community activities and resources. The
				  goal is to increase the beneficiary's independence, productivity, and community
				  inclusion and to support self-directed employees benefits as outlined in the
				  beneficiary's POC.
1. Transportation-community
				  access services are to be included in the beneficiary's plan of care.
2. The beneficiary must be present for the
				  service to be billed.
3. Prior to
				  accessing transportation-community access services, the beneficiary is to
				  utilize free transportation provided by family, friends, and community
				  agencies.
4. When appropriate, the
				  beneficiary should access public transportation or the most cost-effective
				  method of transportation prior to accessing transportation-community access
				  services.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 13 - Residential Options Waiver › Chapter 163 - Covered Services › Section XXI-16339 - Housing Stabilization Transition Services

Current through Register Vol. 50, No. 6, June 20, 2024
A.Housing stabilization transition services
				  enable beneficiaries who are transitioning into a permanent supportive housing
				  unit, including those transitioning from institutions, to secure their own
				  housing. This service is provided while the beneficiary is in an institution
				  and preparing to exit the institution using the waiver. The service includes
				  the following components:
1. conducting a
				  housing assessment to identify the beneficiary's preferences related to housing
				  (i.e., type, location, living alone or with someone else, accommodations
				  needed, and other important preferences), and his/her needs for support to
				  maintain housing, including:
a. access to
				  housing;
b. meeting the terms of a
				  lease;
c. eviction
				  prevention;
d. budgeting for
				  housing/living expenses;
e.
				  obtaining/accessing sources of income necessary for rent;
f. home management;
g. establishing credit; and
h. understanding and meeting the obligations
				  of tenancy as defined in the lease terms;
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 13 - Residential Options Waiver › Chapter 163 - Covered Services › Section XXI-16341 - Housing Stabilization Services

Current through Register Vol. 50, No. 6, June 20, 2024
A.Housing stabilization services enable
				  waiver beneficiaries to maintain their own housing as set forth in the approved
				  plan of care. Services must be provided in the home or a community setting.
				  Housing stabilization services include the following components:
1. conducting a housing assessment
				  identifying the beneficiary's preferences related to housing (type, location,
				  living alone or with someone else, accommodations needed, and other important
				  preferences), and needs for support to maintain housing, including:
a. access to housing;
b. meeting the terms of a lease;
c. eviction prevention;
d. budgeting for housing/living
				  expenses;
e. obtaining/accessing
				  sources of income necessary for rent;
f. home management;
g. establishing credit; and
h. understanding and meeting the obligations
				  of tenancy as defined in the lease terms;
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 13 - Residential Options Waiver › Chapter 163 - Covered Services › Section XXI-16343 - Adult Day Health Care Services

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Adult day health care (ADHC) services shall be furnished as specified in the
				  POC and at an ADHC facility in a non-institutional, community-based setting
				  encompassing both health/medical, and social services needed to ensure the
				  optimal functioning of the beneficiary.
B. ADHC services include those core service
				  requirements identified in the ADHC licensing standards (LAC 48:I.4243), in
				  addition to the following:
1. medical care
				  management;
2. transportation
				  between the beneficiary's place of residence and the ADHC (if the beneficiary
				  is accompanied by the ADHC staff) in accordance with licensing
				  standards;
3. assistance with
				  activities of daily living;
4.
				  health and nutrition counseling;
5.
				  an individualized exercise program;
6. an individualized goal-directed recreation
				  program;
7. health education
				  classes;
8. individualized
				  health/nursing services; and
9.
				  meals. Meals shall not constitute a full nutritional regimen (three meals per
				  day), but shall include a minimum of two snacks and a hot, nutritious lunch per
				  day.
a. Repealed.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 13 - Residential Options Waiver › Chapter 163 - Covered Services › Section XXI-16345 - Monitored In-Home Caregiving Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. Monitored in-home caregiving (MIHC)
				  services are provided to a beneficiary living in a private home with a
				  principal caregiver. The principal caregiver shall be contracted by the
				  licensed HCBS provider having a MIHC service module. The principal caregiver
				  shall reside with the beneficiary. Professional staff employed by the HCBS
				  provider shall provide oversight, support and monitoring of the principal
				  caregiver, service delivery, and beneficiary outcomes through on-site visits,
				  training, and daily webbased electronic information exchange.
1. The goal of this service is to provide a
				  communitybased option that provides continuous care, supports, and professional
				  oversight.
2. This goal is achieved
				  by promoting a cooperative relationship between a beneficiary, a principal
				  caregiver, the professional staff of a monitored in-home caregiver agency
				  provider, and the beneficiary support coordinator.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 13 - Residential Options Waiver › Chapter 165 - Self-Direction Initiative › Section XXI-16501 - Self-Direction Service Option

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Self-direction is a service delivery option which allows beneficiaries (or
				  their authorized representative) to exercise employer authority in the delivery
				  of their authorized self-directed services (community living supports).
1. Beneficiaries are informed of all
				  available services and service delivery options, including self-direction, at
				  the time of the initial assessment, annually, or as requested by beneficiaries
				  or their authorized representative. Beneficiaries, who are interested in
				  self-direction, need only notify their support coordinator, who will facilitate
				  the enrollment process.
2. A
				  contracted fiscal/employer agent is responsible for processing the
				  beneficiary's employer-related payroll, withholding and depositing the required
				  employment-related taxes, and sending payroll reports to the beneficiary or
				  his/her authorized representative.
3. Support coordinators assist beneficiaries
				  by providing the following activities:
a. the
				  development of the beneficiary's plan of care;
b. organizing the unique resources the
				  beneficiary needs;
c. training
				  beneficiaries on their employer responsibilities;
d. completing required forms for
				  participation in self-direction;
e.
				  back-up service planning;
f. budget
				  planning;
g. verifying that
				  potential employees meet program qualifications; and
h. ensuring beneficiary's needs are being met
				  through services.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 13 - Residential Options Waiver › Chapter 167 - Provider Participation › Section XXI-16701 - General Provisions

Current through Register Vol. 50, No. 6, June 20, 2024
A. In order
				  to participate in the Medicaid Program as a provider of services in the
				  Residential Options Waiver, a provider must:
1. meet all of the requirements for licensure
				  and the standards for participation in the Medicaid Program as a home and
				  community-based services provider in accordance with state laws and the rules
				  promulgated by the department;
2.
				  comply with the regulations and requirements specified in LAC 50:XXI, Subparts
				  1 and 13 and the ROW provider manual;
3. comply with all of the state laws and
				  regulations for conducting business in Louisiana, and when applicable, with the
				  state requirements for designation as a non-profit organization; and
4. comply with all of the training
				  requirements for providers of waiver services.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 13 - Residential Options Waiver › Chapter 167 - Provider Participation › Section XXI-16703 - Staffing Restrictions and Requirements

Current through Register Vol. 50, No. 6, June 20, 2024
A. Legally responsible individuals may only
				  be paid for services when the care is extraordinary in comparison to that of a
				  beneficiary of the same age without a disability and the care is in the best
				  interest of the beneficiary.
B.In
				  order to receive payment, relatives must meet the criteria for the provision of
				  the service and the same provider qualifications specified for the service as
				  other providers not related to the beneficiary.
1. Relatives must also comply with the
				  following requirements:
a. become an employee
				  of the beneficiary's agency of choice and meet the same standards as direct
				  support staff who are not related to the individual;
b.become a Medicaid enrolled provider agency;
				  or
c.if the self-direction option
				  is selected, relatives must:
i. become an
				  employee of the self-direction beneficiary; and
ii. have a Medicaid provider agreement
				  executed by the fiscal agent as authorized by the Medicaid
				  agency.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 13 - Residential Options Waiver › Chapter 167 - Provider Participation › Section XXI-16705 - Electronic Visit Verification

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Effective for dates of service on or after July 1, 2015, Residential Options
				  Waiver providers shall use the electronic visit verification (EVV) system
				  designated by the department for automated scheduling, time and attendance
				  tracking, and billing for certain home and community-based services.
B. Reimbursement shall only be made to
				  providers with documented use of the EVV system. The services that require use
				  of the EVV system will be published in the ROW provider manual.
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 13 - Residential Options Waiver › Chapter 169 - Reimbursement › Section XXI-16901 - Unit of Reimbursement

Current through Register Vol. 50, No. 6, June 20, 2024
A.Reimbursement for the following services
				  shall be a prospective flat rate for each approved unit of service provided to
				  the waiver beneficiary. One quarter hour (15 minutes) is the standard unit of
				  service and reimbursement shall not be made for less than one quarter hour of
				  service. This covers both the service provision and administrative costs for
				  these services:
1. respite care;
2. housing stabilization transition;
a. - b. Repealed.
3. housing stabilization;
a. - f. Repealed.
4. community living supports (CLS);
a. up to three beneficiaries may share CLS
				  services if they share a common provider of this service;
b. there is a separate reimbursement rate for
				  CLS when these services are shared;
5. professional services furnished by a/an:
a. psychologist;
b. speech therapist;
c. physical therapist;
d. occupational therapist;
e. social worker;
f. registered dietician;
6. supported employment;
a. individual placement;
b. micro-enterprise;
7. adult day health care;
8. pre-vocational service; and
9. day habilitation.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 13 - Residential Options Waiver › Chapter 169 - Reimbursement › Section XXI-16903 - Direct Service Worker Wages and Bonus Payments

Current through Register Vol. 50, No. 6, June 20, 2024
A. Establishment of Direct Service Worker
				  Wage Floor for Medicaid Home and Community-Based Services for Intellectual and
				  Developmental Disabilities
1. Effective
				  October 1, 2021, providers of Medicaid home and community-based waiver services
				  operated through the Office for Citizens with Developmental Disabilities
				  employing direct service workers will receive the equivalent of a $2.50 per
				  hour rate increase.
2. Effective
				  October 1, 2021, this increase or its equivalent will be applied to all service
				  units provided by direct service workers with an effective date of service for
				  the identified home and community based waiver services provided beginning
				  October 1, 2021.
3. The minimum
				  hourly wage floor paid to direct service workers shall be $9 per
				  hour.
4. All providers of services
				  affected by this rate increase shall be subject to a direct service worker wage
				  floor of $9 per hour. This wage floor is effective for all affected direct
				  service workers of any work status, whether full-time or part-time.
5. The Department of Health reserves the
				  right to adjust the direct service worker wage floor as needed through
				  appropriate rulemaking promulgation consistent with the Louisiana
				  Administrative Procedure Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 13 - Residential Options Waiver › Chapter 169 - Reimbursement › Section XXI-16905 - Support Coordination

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Establishment of Support Coordination Workforce Bonus Payments
1. Support coordination providers who
				  provided services from April 1, 2021 to October 31, 2022 shall receive bonus
				  payments of $300 per month for those months for each support coordination
				  worker that worked with participants for those months.
2. The support coordination worker that
				  worked with participants from April 1, 2021 to October 31, 2022 must receive at
				  least $250 of this $300 bonus payment paid to the provider. This bonus payment
				  is effective for all eligible support coordination workers of any working
				  status, whether full-time or part-time.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 15 - Adult Residential Care › Chapter 301 - General Provisions [Repealed] › Section XXI-30101 - Introduction [Repealed]

Current through Register Vol. 50, No. 6, June 20, 2024
AUTHORITY
					 NOTE: Promulgated in accordance with
					 R.S.
					 36:254 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 15 - Adult Residential Care › Chapter 301 - General Provisions [Repealed] › Section XXI-30103 - Target Population [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 15 - Adult Residential Care › Chapter 301 - General Provisions [Repealed] › Section XXI-30105 - Request for Services Registry [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 15 - Adult Residential Care › Chapter 301 - General Provisions [Repealed] › Section XXI-30107 - Programmatic Allocation of Waiver Opportunities [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 15 - Adult Residential Care › Chapter 301 - General Provisions [Repealed] › Section XXI-30109 - Waiver Costs Limit [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 15 - Adult Residential Care › Chapter 303 - Services [Repealed] › Section XXI-30301 - Covered Services [Repealed]

Current through Register Vol. 50, No. 6, June 20, 2024
AUTHORITY
					 NOTE: Promulgated in accordance with
					 R.S.
					 36:254 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 15 - Adult Residential Care › Chapter 303 - Services [Repealed] › Section XXI-30303 - Comprehensive Plan of 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 XXI - Home and Community-Based Services Waivers › Subpart 15 - Adult Residential Care › Chapter 305 - Admission and Discharge Criteria [Repealed] › Section XXI-30501 - Admission Criteria [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 15 - Adult Residential Care › Chapter 305 - Admission and Discharge Criteria [Repealed] › Section XXI-30503 - Admission Denial or Discharge Criteria [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 15 - Adult Residential Care › Chapter 307 - Provider Participation [Repealed] › Section XXI-30701 - ARC Provider Responsibilities [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 15 - Adult Residential Care › Chapter 307 - Provider Participation [Repealed] › Section XXI-30703 - Support Coordination Agency Responsibilities [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 15 - Adult Residential Care › Chapter 307 - Provider Participation [Repealed] › Section XXI-30705 - Reporting Requirements [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 15 - Adult Residential Care › Chapter 307 - Provider Participation [Repealed] › Section XXI-30707 - Recordkeeping [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 15 - Adult Residential Care › Chapter 309 - Reimbursement [Repealed] › Section XXI-30901 - General Provisions [Repealed]

Current through Register Vol. 50, No. 6, June 20, 2024
AUTHORITY
					 NOTE: Promulgated in accordance with
					 R.S.
					 36:254 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 15 - Adult Residential Care › Chapter 309 - Reimbursement [Repealed] › Section XXI-30903 - 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 15 - Adult Residential Care › Chapter 309 - Reimbursement [Repealed] › Section XXI-30905 - Room and Board [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 15 - Adult Residential Care › Chapter 309 - Reimbursement [Repealed] › Section XXI-30907 - Cost Reporting [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.