Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 101 - Standards for Payment for Nursing Facilities › Subchapter B - General Provisions › Section II-10103 - Certification

Current through Register Vol. 50, No. 6, June 20, 2024
A. Certification of
					 title XVIII (Medicare)/ skilled nursing facilities (SNF). DHH shall obtain a
					 certification notice from the Secretary of the Department of Health and Human
					 Services (DHHS) that verifies a skilled nursing facility is qualified to
					 participate in the Title XVIII Program. The facility shall request a
					 certification packet from BHSF/HSS state office.
B. Certification of Title XIX
					 (Medicaid)/Nursing Facilities (NF)
1. To
					 participate in title XIX (Medicaid Program), a nursing facility must have
					 facility need review approval, be enrolled as a provider, and be in compliance
					 with the requirements for participation established by federal regulations. A
					 nursing facility may participate in the Medicaid program by meeting the
					 requirements.
2. A facility must
					 obtain licensure of the beds prior to or in conjunction with the request for
					 certification of beds. Licensure of beds is performed by BHSF/HSS. For Medicaid
					 Program participation, all beds to be certified in the Medicaid Program shall
					 be licensed nursing facility beds.
3. Instructions and forms are contained in
					 the packet for the NF to follow to initiate the certification process. These
					 include but are not limited to the following.
4. Facility Need Review. Facility need review
					 approval must be obtained for Medicaid participation. The facility shall secure
					 approval from the Facility Need Review Program to certify that there is no
					 cause to deny the facility from participation in the Medicaid program on the
					 basis of need. The approval shall designate the appropriate name of the legal
					 entity operating the facility and the number of beds eligible for Medicaid
					 program enrollment. If the approval is not issued in the complete name of the
					 legal entity operating the facility, evidence shall be provided to verify that
					 the legal entity which obtained the original approval is the same legal entity
					 operating the facility.
5.
					 Disclosure Requirement
a. As part of the
					 certification requirement, all Medicaid Program participating facilities shall
					 supply BHSF/HSS with a completed Disclosure of Ownership Control Interest
					 statement, HCFA 1513, which requires information as to the identity of the
					 following individuals:
i. each person having
					 a direct or indirect ownership interest in the facility of five percent or
					 more;
ii. each owner (in whole or
					 in part) with a five percent interest in any property, assets, mortgage, deed
					 of trust, note, or other obligation secured by the facility;
iii. each officer and director when a
					 facility is organized as a corporation;
iv. each partner when a facility is organized
					 as a partnership; and
v. within 35
					 days from the date of request, the provider shall submit full and complete
					 information, as specified by the BHSF, regarding the following:
(a). the ownership of any subcontractor with
					 whom the facility has had more than $25,000 in business transactions during the
					 previous 12 months; and
(b).
					 information as to any significant business transactions between the facility
					 and the subcontractor or wholly owned suppliers during the previous five years.
b. The
					 Department of Health and Hospitals Health Standards Section shall arrange for
					 on-site surveys for compliance with Medicaid and title VI (civil rights), life
					 safety, and sanitation. The effective date of certification can be no earlier
					 than the completion date of the survey, assuming all requirements are met. If
					 requirements are not met at the time of survey, then the certification date may
					 be delayed at the discretion of the state agency either until the facility
					 signs an acceptable plan of correction or a follow-up visit verifies
					 substantial compliance.
6. Change in Certification
a. A facility wishing to change its
					 participation from Medicare/Medicaid (SNF-NF) to Medicaid (NF) or from Medicaid
					 (NF) to Medicare/Medicaid (SNF-NF) shall submit to the Health Standards Section
					 a letter of intent. Once the facility has been determined eligible to
					 participate, the Medicaid Program (Medicaid) provider agreement will be amended
					 accordingly.
b. Bed certification
					 change - a facility wishing to change the number of beds in either category
					 (Medicare or Medicaid) shall submit to DHH a letter of intent.