reglab/statecodes huggingface dataset:
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 103 - Standards for Payment for Intermediate Care Facilities for the Mentally Retarded (ICF/MR) › Subchapter H - Emergency Awareness › Section II-10383 - Audits

Current through Register Vol. 50, No. 6, June 20, 2024
A. Each ICF-MR
					 shall file an annual facility cost report and a central office cost
					 report.
B. ICF-MR 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 DHH.
1. A representative sample
					 of the ICF-MR 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 DHH.
3. DHH conducts desk reviews of all the cost
					 reports received. DHH also conducts on-site audits of provider records and cost
					 reports.
a. DHH 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 DHH on Medicaid cost reports, including
					 related-party transactions and other business activities engaged in by the
					 provider, must be accessible to DHH audit staff in the state of
					 Louisiana.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 103 - Standards for Payment for Intermediate Care Facilities for the Mentally Retarded (ICF/MR) › Subchapter H - Emergency Awareness › Section II-10385 - 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 II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 109 - Standards for Payment-Adult Day Health Care Services › Section II-10901 - Forward (Repealed)

Current through Register Vol. 50, No. 6, June 20, 2024
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 46:153 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 109 - Standards for Payment-Adult Day Health Care Services › Section II-10903 - Program Description (Repealed)

Current through Register Vol. 50, No. 6, June 20, 2024
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 46:153 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 109 - Standards for Payment-Adult Day Health Care Services › Section II-10905 - Definitions (Repealed)

Current through Register Vol. 50, No. 6, June 20, 2024
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 46:153 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 109 - Standards for Payment-Adult Day Health Care Services › Section II-10907 - Licensure (Repealed)

Current through Register Vol. 50, No. 6, June 20, 2024
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 46:153 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 109 - Standards for Payment-Adult Day Health Care Services › Section II-10909 - Provider Agreement (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 II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 109 - Standards for Payment-Adult Day Health Care Services › Section II-10911 - Interdisciplinary (ID) Team (Repealed)

Current through Register Vol. 50, No. 6, June 20, 2024
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 46:153 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 109 - Standards for Payment-Adult Day Health Care Services › Section II-10913 - ID Team Assessments (Repealed)

Current through Register Vol. 50, No. 6, June 20, 2024
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 46:153 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 109 - Standards for Payment-Adult Day Health Care Services › Section II-10915 - Staffings (Repealed)

Current through Register Vol. 50, No. 6, June 20, 2024
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 46:153 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 109 - Standards for Payment-Adult Day Health Care Services › Section II-10917 - Plan of Care (Repealed)

Current through Register Vol. 50, No. 6, June 20, 2024
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 46:153 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 109 - Standards for Payment-Adult Day Health Care Services › Section II-10919 - Progress Notes (Repealed)

Current through Register Vol. 50, No. 6, June 20, 2024
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 46:153 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 109 - Standards for Payment-Adult Day Health Care Services › Section II-10921 - Services to be Provided (Repealed)

Current through Register Vol. 50, No. 6, June 20, 2024
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 46:153 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 109 - Standards for Payment-Adult Day Health Care Services › Section II-10923 - Participant Rights (Repealed)

Current through Register Vol. 50, No. 6, June 20, 2024
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 46:153 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 109 - Standards for Payment-Adult Day Health Care Services › Section II-10925 - Eligibility Criteria for Adult Day Health Care Certification (Repealed)

Current through Register Vol. 50, No. 6, June 20, 2024
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 46:153 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 109 - Standards for Payment-Adult Day Health Care Services › Section II-10927 - BHSF Admission Assessment/Vendor Payment (Repealed)

Current through Register Vol. 50, No. 6, June 20, 2024
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 46:153 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 109 - Standards for Payment-Adult Day Health Care Services › Section II-10929 - Utilization Review (UR) (Repealed)

Current through Register Vol. 50, No. 6, June 20, 2024
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 46:153 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 109 - Standards for Payment-Adult Day Health Care Services › Section II-10931 - Inspection of Care (Repealed)

Current through Register Vol. 50, No. 6, June 20, 2024
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 46:153 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 109 - Standards for Payment-Adult Day Health Care Services › Section II-10933 - Discharge Planning and Implementation (Repealed)

Current through Register Vol. 50, No. 6, June 20, 2024
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 46:153 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 109 - Standards for Payment-Adult Day Health Care Services › Section II-10935 - Incident Reports (Repealed)

Current through Register Vol. 50, No. 6, June 20, 2024
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 46:153 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 109 - Standards for Payment-Adult Day Health Care Services › Section II-10937 - Complaint Procedure (Repealed)

Current through Register Vol. 50, No. 6, June 20, 2024
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 46:153 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 109 - Standards for Payment-Adult Day Health Care Services › Section II-10939 - Prospective Payment System (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.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 36:254 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 109 - Standards for Payment-Adult Day Health Care Services › Section II-10941 - Participant Records (Repealed)

Current through Register Vol. 50, No. 6, June 20, 2024
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 46:153 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 109 - Standards for Payment-Adult Day Health Care Services › Section II-10945 - Audits (Repealed)

Current through Register Vol. 50, No. 6, June 20, 2024
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 46:153 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 109 - Standards for Payment-Adult Day Health Care Services › Section II-10947 - Compliance with Standards for Payment (Repealed)

Current through Register Vol. 50, No. 6, June 20, 2024
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 46:153 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 5 - Reimbursement › Chapter 200 - Reimbursement Methodology › Section II-20003 - Cost Reports [Formerly LAC 50:VII.1303]

Current through Register Vol. 50, No. 6, June 20, 2024
A. Nursing facility providers under Title XIX
				  are required to file annual cost reports as follows.
1. Providers of nursing facility level of
				  care are required to report all reasonable and allowable cost on a regular
				  nursing facility cost report. Effective for periods ending on or after June 30,
				  2002, the regular nursing facility cost report will be the skilled nursing
				  facility cost report adopted by the Medicare program, hereafter referred to as
				  the Medicare cost report. This cost report is frequently referred to as the
				  Health Care Financing Administration (HCFA) 2540. The cost reporting period
				  begin date shall be the later of the first day of the facility's fiscal period
				  or the facility's certification date. The cost reporting end date shall be the
				  earlier of the last day of the facility's fiscal period or the final day of
				  operation as a nursing facility.
2.
				  In addition to filing the Medicare cost report, nursing facility providers must
				  also file supplemental schedules designated by the bureau. Facilities shall
				  submit their Medicare cost report and their state Medicaid supplemental cost
				  report in accordance with procedures established by the department.
3. Separate cost reports must be submitted by
				  central/home offices when costs of the central/home office are reported in the
				  facility's cost report.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 5 - Reimbursement › Chapter 200 - Reimbursement Methodology › Section II-20005 - Rate Determination

Current through Register Vol. 50, No. 6, June 20, 2024
A. For
				  dates of service on or after July 1, 2002, each nursing facility's rate for
				  skilled nursing (SN), intermediate care I (IC-I) and intermediate care II
				  (IC-II) services shall be the daily rates for these services in effect on June
				  30, 2002 as adjusted by legislative appropriations for state fiscal year
				  2003.
B. For dates of service on or
				  after January 1, 2003, the Medicaid daily rates shall be based on a case-mix
				  price-based reimbursement system. Rates shall be calculated from cost report
				  and other statistical data.
1.Effective July
				  3, 2009, and at a minimum, every second year thereafter, the base
				  resident-day-weighted median costs and prices shall be rebased using the most
				  recent four month or greater unqualified audited or desk reviewed cost reports
				  that are available as of the April 1, prior to the July 1, rate setting or the
				  department may apply a historic audit adjustment factor to the most recently
				  filed cost reports. The department, at its discretion, may rebase at an earlier
				  time.
a. For rate periods between rebasing,
				  an index factor shall be applied to the base resident-day weighted medians and
				  prices.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 5 - Reimbursement › Chapter 200 - Reimbursement Methodology › Section II-20006 - Reimbursement Adjustment [Formerly LAC 50:VII.1306]

Current through Register Vol. 50, No. 6, June 20, 2024
A. Effective for dates of service on or after
				  January 1, 2004, for state fiscal year 2003-2004 only, each private nursing
				  facility's per diem case mix adjusted rate shall be reduced by $0.67.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 36:254 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 5 - Reimbursement › Chapter 200 - Reimbursement Methodology › Section II-20007 - Case-Mix Index Calculation [Formerly LAC 50:VII.1307]

Current through Register Vol. 50, No. 6, June 20, 2024
A. The Resource Utilization Groups-III
				  (RUG-III) Version 5.20, 34-group, or its successor, index maximizer model shall
				  be used as the resident classification system to determine all case-mix
				  indices, using data from the minimum data set (MDS) submitted by each facility.
				  Standard Version 5.20, or its successor, case-mix indices developed by CMS
				  shall be the basis for calculating average case-mix indices to be used to
				  adjust the direct care cost component. Resident assessments that cannot be
				  classified to a RUG-III group, or its successor, will be excluded from the
				  average case-mix index calculation.
B. Each resident in the nursing facility,
				  with a completed and submitted assessment, shall be assigned a RUG-III,
				  34-group, or its successor based on the following criteria.
1. Prior to the January 1, 2017 rate setting,
				  the RUG-III group, or its successor, is calculated based on the resident's most
				  current assessment, available on the last day of each calendar quarter, and
				  shall be translated to the appropriate case mix index. From the individual
				  resident case mix indices, two average case mix indices for each Medicaid
				  nursing facility provider shall be determined four times per year based on the
				  last day of each calendar quarter.
2. Effective as of the January 1, 2017 rate
				  setting, the RUG-III group, or its successor, will be calculated using each
				  resident MDS assessment transmitted and accepted by CMS that is considered
				  active within a given calendar quarter. These assessments are then translated
				  to the appropriate case mix index. The individual resident case mix indices are
				  then weighted based on the number of calendar days each assessment is active
				  within a given calendar quarter. Using the individual resident case mix
				  indices, the calendar day weighted average nursing facility-wide case mix index
				  is calculated using all residents regardless of payer type. The calendar day
				  weighted nursing facility-wide average case mix index for each Medicaid nursing
				  facility shall be determined four times per year.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 5 - Reimbursement › Chapter 200 - Reimbursement Methodology › Section II-20009 - Non-State, Government Owned or Operated Facilities and State-Owned or Operated Facilities

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Non-state, government-owned or operated nursing facilities will be paid a
				  case-mix reimbursement rate in accordance with §1305.
B. State-owned or operated nursing facilities
				  will be paid a prospective per diem rate. The per diem payment rate for each of
				  these facilities will be calculated annually on July 1, using the nursing
				  facility's allowable cost from the most recently filed Medicaid cost report
				  trended forward from the midpoint of the cost report year to the midpoint of
				  the rate year using the index factor.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 36:254,
					 R.S.
					 46:2742, and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 5 - Reimbursement › Chapter 200 - Reimbursement Methodology › Section II-20010 - Additional Payments and Square Footage Adjustments for Private Room Conversion [Formerly LAC 50:VII.1310]

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Effective for dates of service on or after September 1, 2007, Medicaid
				  participating nursing facilities that convert a semi-private room to a
				  Medicaid-occupied private room are eligible to receive an additional $5 per
				  diem payment. Facilities that participate will have their fair rental value per
				  diem revised based on the change in licensed beds.
B. Qualifying Facilities
1. In order for a nursing facility's beds to
				  qualify for an additional $5 per diem payment, a revised fair rental value
				  (FRV), a revised property tax pass-through, and revised property insurance
				  pass-through, all of the following conditions must be met.
a. The nursing facility must convert one or
				  more semi-private rooms to private rooms on or after September 1,
				  2007.
b. The converted private
				  room(s) must be occupied by a Medicaid resident(s) to receive the $5 per diem
				  payment.
c. The nursing facility
				  must surrender their bed licenses equal to the number of converted private
				  rooms.
d. The nursing facility must
				  submit the following information to the department within 30 days of the
				  private room conversion:
i. the number of
				  rooms converted from semi-private to private;
ii. the revised bed license;
iii. a resident listing by payer type for the
				  converted private rooms; and
iv.
				  the date of the conversions.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 5 - Reimbursement › Chapter 200 - Reimbursement Methodology › Section II-20012 - Fair Rental Value, Property Tax and Property Insurance Incentive Payments to Buyers of Nursing Facilities [Formerly LAC 50:VII.1312]

Current through Register Vol. 50, No. 6, June 20, 2024
A. On or after July 20, 2007, a Louisiana
				  Medicaid participating nursing facility [buyer(s)] that purchases and closes an
				  existing Louisiana Medicaid participating nursing facility (seller) will be
				  eligible to receive fair rental value, property tax and property insurance
				  incentive payments for five years after the legal transfer of ownership and
				  closure of the seller's nursing facility.
B. Qualifying Buyer(s). In order for the
				  buying facility to qualify for the incentive payments described in this
				  Section, the following conditions must be met.
1. Buyer(s) must purchase and close a
				  Medicaid-certified nursing facility within 90 days after the legal transfer of
				  ownership from the seller to buyer(s).
2. After closing the facility, all buyer(s)
				  must permanently surrender their interest in the seller's bed license and the
				  Facility Need Review bed approvals to the state.
3. The buyer(s) must be a Medicaid-certified
				  nursing facility operator(s) at the time of purchase and continue their
				  Medicaid participation throughout the entire five year payment period. A change
				  in ownership of a buyer facility will not be considered a break in Medicaid
				  participation provided the new owner of the nursing facility continues
				  participation in the Medicaid Program as a Medicaid-certified nursing
				  facility.
4. The buyer(s) must
				  provide the following documentation to the secretary of the department, in
				  writing, within 30 days after the legal transfer of ownership:
a. a list of all buyer(s);
b. a list of all seller(s);
c. the date of the legal transfer of
				  ownership;
d. each buyer's
				  percentage share of the purchased facility; and
e. each buyer's current nursing facility
				  resident listing and total occupancy calculations as of the date of the legal
				  transfer of ownership.
5. The buyer(s) must provide the following
				  documentation to the secretary of the department, in writing, within 110 days
				  after the legal transfer of ownership:
a. a
				  list of the nursing facility residents that transferred from the seller
				  facility and were residents of the buyer facility as of 90 days after the legal
				  transfer of ownership date. The nursing facility resident list must include the
				  payer source for each resident;
b.
				  the date that the seller's facility was officially closed and no longer
				  operating as a nursing facility.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 5 - Reimbursement › Chapter 200 - Reimbursement Methodology › Section II-20013 - Case-Mix Documentation Reviews and Case-Mix Index Reports [Formerly LAC 50:VII.1313]

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				  department shall provide each nursing facility provider with the preliminary
				  case-mix index report (PCIR) by approximately the fifteenth day of the second
				  month following the beginning of a calendar quarter. The PCIR will serve as
				  notice of the MDS assessments transmitted and provide an opportunity for the
				  nursing facility provider to correct and transmit any missing MDS assessments
				  or tracking records or apply the CMS correction request process where
				  applicable. The department shall provide each nursing facility provider with a
				  final case-mix index report (FCIR) utilizing MDS assessments after allowing the
				  nursing facility providers a reasonable amount of time to process their
				  corrections (approximately two weeks).
1. If
				  the department determines that a nursing facility provider has delinquent MDS
				  resident assessments, for purposes of determining both average CMIs, such
				  assessments shall be assigned the case-mix index associated with the RUG-III
				  group "BC1-delinquent" or its successor. A delinquent MDS shall be assigned a
				  CMI value equal to the lowest CMI in the RUG-III, or its successor,
				  classification system.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 5 - Reimbursement › Chapter 200 - Reimbursement Methodology › Section II-20015 - Appeal Process [Formerly LAC 50:VII.1315]

Current through Register Vol. 50, No. 6, June 20, 2024
A. If the facility disagrees with the CMDR
				  findings, a written request for an informal reconsideration must be submitted
				  to the department within 15 business days of the facilitys receipt of the CMDR
				  findings in the SRR letter. Otherwise, the results of the CMDR findings are
				  considered final and not subject to appeal. The department will review the
				  facilitys informal reconsideration request within 10 business days of receipt
				  of the request and will send written notification of the final results of the
				  reconsideration to the facility. No appeal of findings will be accepted until
				  after communication of final results of the informal reconsideration
				  process.
B. The provider has the
				  right to request an appeal within 30 days of the written notice of the results
				  of the informal reconsideration. Such request must be in writing to the Appeals
				  Section. The request must contain a statement and be accompanied by supporting
				  documents setting forth with particularity those asserted discrepancies which
				  the provider contends are in compliance with the agency's regulations and the
				  reasons for such contentions.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 36:254,
					 R.S.
					 46:2742, and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 5 - Reimbursement › Chapter 200 - Reimbursement Methodology › Section II-20017 - Reimbursement for Fire Sprinkler Systems and Two-Hour Rated Wall Installations [Formerly LAC 50:VII.1317]

Current through Register Vol. 50, No. 6, June 20, 2024
A. All
				  nursing facilities are required to be protected throughout by a fire sprinkler
				  system by January 1, 2008. Where means of egress passes through building areas
				  outside of a nursing facility, those areas shall be separated from the nursing
				  facility by a two-hour rated wall or shall be protected by a fire sprinkler
				  system.
B. Nursing Facility
				  Procedure and Documentation Requirements
1. A
				  completed fire sprinkler system plan or two-hour rated wall plan, or both, must
				  be submitted to the department for review and approval by December 31,
				  2006.
2. Upon approval of the plans
				  and after installation is completed, nursing facilities must submit auditable
				  depreciation schedules and invoices to support the installation cost of all
				  fire sprinkler systems and two-hour rated walls. The documentation must be
				  submitted to the department or its designee.
a. All supporting documentation, including
				  depreciation schedules and invoices, must indicate if the cost was previously
				  included in a fair rental value re-age request.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 5 - Reimbursement › Chapter 200 - Reimbursement Methodology › Section II-20019 - Evacuation and Temporary Sheltering Costs [Formerly LAC 50:VII.1319]

Current through Register Vol. 50, No. 6, June 20, 2024
A. Nursing
				  facilities 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. Nursing
				  facilities 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. Nursing facilities
				  must submit expense and reimbursement documentation directly related to the
				  evacuation or temporary sheltering of Medicaid nursing home residents to the
				  department.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 5 - Reimbursement › Chapter 200 - Reimbursement Methodology › Section II-20021 - Leave of Absence Days [Formerly LAC 50:VII.1321]

Current through Register Vol. 50, No. 6, June 20, 2024
A. For each Medicaid recipient, nursing
				  facilities shall be reimbursed for up to seven hospital leave of absence days
				  per occurrence and 15 home leave of absence days per year.
B. The reimbursement for hospital leave of
				  absence days is 75 percent of the applicable per diem rate.
C. Nursing facilities with occupancy rates
				  less than 90 percent. Effective for dates of service on or after February 20,
				  2009, reimbursement for hospital and home leave of absence days will be reduced
				  to 10 percent of the applicable per diem rate in addition to the nursing
				  facility provider fee.
D. Nursing
				  facilities with occupancy rates equal to or greater than 90 percent. Effective
				  for dates of service on or after February 20, 2009, the reimbursement paid for
				  home leave of absence days will be reduced to 90 percent of the applicable per
				  diem rate, which includes the nursing facility provider fee.
1. Effective for dates of service on or after
				  March 1, 2009, the reimbursement for hospital leave of absence days for nursing
				  facilities with occupancy rates equal to or greater than 90 percent shall be 90
				  percent of the applicable per diem rate, which includes the nursing facility
				  provider fee.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 5 - Reimbursement › Chapter 200 - Reimbursement Methodology › Section II-20023 - Transition of State-Owned or Operated Nursing Facility to a Private Facility

Current through Register Vol. 50, No. 6, June 20, 2024
A. A state owned or
				  operated nursing facility that changes ownership (CHOW) in order to transition
				  to a private nursing facility will be exempt from the case-mix direct care and
				  care-related spending floor for a period of 12 months following the effective
				  date of the CHOW under the following conditions:
1. the state-owned or operated facility is
				  located in the DHH administrative region 1; and
2. the change of ownership is the result of a
				  leasing arrangement.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 5 - Reimbursement › Chapter 200 - Reimbursement Methodology › Section II-20024 - Transition of Private Nursing Facility to a State-Owned or Operated Nursing Facility through a Change of Ownership

Current through Register Vol. 50, No. 6, June 20, 2024
A. Any private nursing facility that
				  undergoes a change of ownership (CHOW) to a state-owned or operated nursing
				  facility will be exempt from the prospective reimbursement system for public
				  nursing facilities during the transitional period.
1. The transitional period will be effective
				  from the date of the CHOW until the July 1 rate setting period following when
				  the state-owned or operated nursing facility has an audited or reviewed 12
				  month or greater cost reporting period available for use in rate
				  setting.
2. After the transitional
				  period, the nursing facility will be reimbursed pursuant to the requirements of
				  the prospective reimbursement system for public nursing facilities.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 5 - Reimbursement › Chapter 200 - Reimbursement Methodology › Section II-20025 - Low Income and Needy Care Collaboration

Current through Register Vol. 50, No. 6, June 20, 2024
A. Effective for dates of service on or after
				  November 1, 2011, quarterly supplemental payments shall be issued to qualifying
				  nursing facilities for services rendered during the quarter. Maximum aggregate
				  payments to all qualifying nursing facilities shall not exceed the available
				  upper payment limit per state fiscal year.
B. Qualifying Criteria. In order to qualify
				  for the supplemental payment, the nursing facility must be affiliated with a
				  state or local governmental entity through a low income and needy care nursing
				  facility collaboration agreement.
1. A
				  nursing facility is defined as a currently licensed and certified nursing
				  facility which is owned or operated by a private entity or non-state
				  governmental entity.
2. A low
				  income and needy care nursing facility collaboration agreement is defined as an
				  agreement between a nursing facility and a state or local governmental entity
				  to collaborate for purposes of providing healthcare services to low income and
				  needy patients.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 5 - Reimbursement › Chapter 200 - Reimbursement Methodology › Section II-20026 - Geriatric Training Nursing Facility Reimbursement Rate

Current through Register Vol. 50, No. 6, June 20, 2024
Note: The provisions of this Section shall be subject to
					 approval by the U.S. Department of Health and Human Services, Centers for
					 Medicare and Medicaid Services (CMS) of a State Plan amendment authorizing such
					 payment.
A. Effective for dates of
				  service on or after July 1, 2019, LDH shall provide a private nursing facility
				  reimbursement rate of $365.68 per resident per day to an entity that meets the
				  following criteria:
1. the entity has a
				  cooperative endeavor agreement (CEA) with Louisiana State University (LSU) to
				  operate the current John J. Hainkel, Jr. Home and Rehabilitation Center or any
				  other future location used to operate John J. Hainkel, Jr. Home and
				  Rehabilitation Center which has been approved by the parties and the
				  department, as a geriatric training nursing facility.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 5 - Reimbursement › Chapter 200 - Reimbursement Methodology › Section II-20027 - Specialized Care Reimbursement

Current through Register Vol. 50, No. 6, June 20, 2024
A. A
				  specialized care reimbursement rate shall consist of a nursing facility's
				  Medicaid case-mix reimbursement rate plus an add-on amount. These rates can be
				  established by the department for a specialized care unit.
B. Nursing Facility Specialized Care Unit
				  Reimbursement
1. Effective with the January
				  1, 2014 rate period, infectious disease (ID) specialized care costs will no
				  longer be reimbursed through a separate per diem add-on payment. ID costs and
				  days will be included in the calculation of the case-mix nursing facility
				  reimbursement rates and the direct care and care-related floor calculation as
				  described under
				  §20005 of this Chapter.
2. Effective with the January 1, 2014 rate
				  period, technologically dependent care (TDC) costs and days will be included in
				  the calculation of the case-mix nursing facility reimbursement rates and the
				  direct care and care-related floor calculation as described under
				  §20005 of this Chapter. TDC services
				  will continue to be reimbursed through a separate per diem add-on payment. The
				  department will be solely responsible for determining adjustments to the TDC
				  per diem add-on payment.
3.
				  Effective with the January 1, 2014 rate period, Neurological Rehabilitation
				  Treatment Program (NRTP) costs and days for both rehabilitative and complex
				  services will be included in the calculation of the case-mix nursing facility
				  reimbursement rates and the direct care and care-related floor calculation as
				  described under
				  §20005 of this Chapter. NRTP services
				  will be reimbursed through a separate per diem add-on payment. The department
				  will be solely responsible for determining adjustments to the NRTP per diem
				  add-on payment.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 5 - Reimbursement › Chapter 200 - Reimbursement Methodology › Section II-20029 - Supplemental Payments

Current through Register Vol. 50, No. 6, June 20, 2024
A. Non-State
				  Governmental Organization Nursing Facilities
1. Effective for dates of service on or after
				  January 20, 2016, any nursing facility that is owned or operated by a non-state
				  governmental organization (NSGO), and that has entered into an agreement with
				  the department to participate, shall qualify for a Medicaid supplemental
				  payment adjustment, in addition to the uniform Medicaid rates paid to nursing
				  facilities. The only qualifying nursing facilities are:
a. Gueydan Memorial Guest Home;
b. LaSalle Nursing Home;
c. Natchitoches Parish Hospital LTC Unit;
				  and
d. St. Helena Parish Nursing
				  Home.
e. Repealed.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part III - Eligibility › Subpart 1 - General Administration › Chapter 1 - General Provisions › Section III-101 - Fair Hearings

Current through Register Vol. 50, No. 6, June 20, 2024
A. Every
				  applicant for, and enrollee of, Medicaid Program benefits has the right to
				  appeal an agency action or decision, and has the right to request a fair
				  hearing in the presence of an impartial hearing officer.
1.
Action
-a termination,
				  suspension or reduction of Medicaid eligibility or covered services. This
				  includes terminations by skilled nursing facilities and nursing facilities to
				  transfer or discharge residents and adverse determinations made by a state
				  (Medicaid Program) with regard to the preadmission screening and annual
				  resident review requirements of §1917(e)(7) of the Social Security
				  Act.
2. Exception. Enrollees are
				  not entitled to a fair hearing if the sole issue is a federal or state law
				  requiring an automatic change adversely affecting some or all Medicaid
				  recipients.
3. Applicants and
				  enrollees shall be informed in writing of the right to request a fair hearing
				  and of the procedure to do so.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part III - Eligibility › Subpart 1 - General Administration › Chapter 3 - Asset Verification Program › Section III-301 - General Provisions

Current through Register Vol. 50, No. 6, June 20, 2024
A. Pursuant
				  to §7001(d) of the Supplemental Appropriations Act of 2008 (P.L.
				  110-252) and §1940 of the Social Security Act, the
				  department hereby establishes provisions to implement an Asset Verification
				  Program (AVP) for Louisiana Medicaid.
B. The department will provide for the
				  verification of assets for the purposes of determining or redetermining
				  (renewing) Medicaid eligibility for aged, blind and disabled Medicaid
				  applicants and recipients of Medicaid using an asset verification system (AVS)
				  which meets the following requirements.
1.
				  The request and response system will be an electronic system and meet the
				  following criteria.
a. Verification inquiries
				  will be sent electronically via the internet or similar means from Medicaid to
				  the financial institution (FI).
b.
				  The system will not be based on mailing paper-based requests.
c. The system will have the capability to
				  accept responses electronically.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part III - Eligibility › Subpart 1 - General Administration › Chapter 5 - Application Processing › Section III-501 - Filing Application

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				  bureau requires an applicant to complete and sign a written application in
				  order to initiate the eligibility determination process for Medicaid benefits.
				  The applicant's signature on the application affirms that all of the
				  information contained on the form is true and correct or the applicant could be
				  subject to a penalty for perjury. In order to facilitate the application
				  process, the Bureau authorizes the electronic filing of Medicaid applications.
				  Applications may be signed by the following means:
1. the applicant's signature on a paper
				  application;
2. a personal
				  identification number (PIN); or a digital signature as issued by DHH (in the
				  Louisiana Medicaid Manual).
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part III - Eligibility › Subpart 1 - General Administration › Chapter 5 - Application Processing › Section III-503 - Application Date

Current through Register Vol. 50, No. 6, June 20, 2024
A. The application
				  date shall be the date the signed Medicaid application is received in the local
				  Medicaid office or in an agency representative's office.
B. The date of receipt shall be protected as
				  the certified date of application, as determined by Subsection A
				  above.
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 III - Eligibility › Subpart 1 - General Administration › Chapter 5 - Application Processing › Section III-505 - Federally-Facilitated Marketplace Determinations

Current through Register Vol. 50, No. 6, June 20, 2024
A. Effective April 20, 2016, Louisiana
				  Medicaid will delegate its Medicaid eligibility determination authority to the
				  federally-facilitated marketplace (FFM) in order to begin accepting eligibility
				  determinations made by the FFM for only those individuals who apply for
				  healthcare coverage through the FFM. This action will result in the state
				  becoming a determination state.
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 III - Eligibility › Subpart 1 - General Administration › Chapter 9 - Financial Eligibility › Subchapter D - Incurred Medical › Section III-939 - Medically Needy

Current through Register Vol. 50, No. 6, June 20, 2024
A. The following
					 criteria apply to all incurred medical expenses for medically needy.
1. Bills for necessary medical and remedial
					 services furnished more than three months before the Medicaid application is
					 filed will be excluded as an incurred expense. Current payments on excluded
					 expenses will be allowed as an incurred expense.
2. The first budget period for the Medically
					 Needy will begin the first month in the three-month period prior to the date of
					 application in which the applicant received covered services.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part III - Eligibility › Subpart 1 - General Administration › Chapter 9 - Financial Eligibility › Subchapter D - Incurred Medical › Section III-941 - Incurred Medical and Remedial Care Expenses

Current through Register Vol. 50, No. 6, June 20, 2024
A. In accordance with 42 C.F.R. Part 435
					 Subparts H and I, certain medical and remedial care expenses incurred by
					 institutionalized individuals and individuals receiving home and
					 community-based services furnished under a waiver, subject to the reasonable
					 limits specified herein, are deducted from the individual's income in the
					 calculation of patient liability.
B. Reasonable limits imposed are:
1. For medically necessary care, services,
					 and items not paid under the Medicaid State Plan or, if covered under the
					 Medicaid State Plan, denied due to service limitations.
a. The medical or remedial care must be:
i. recognized under state law;
ii. medically necessary as verified by an
					 independent licensed physician or medical director; and
iii. incurred no earlier than three months
					 preceding the month in which it is reported to the state; and
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part III - Eligibility › Subpart 1 - General Administration › Chapter 11 - Express Lane Eligibility › Section III-1101 - General Provisions

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				  Children's Health Insurance Program Reauthorization Act (CHIPRA) of 2009,
				  Public Law No. 111-3, established provisions which allowed states to rely on a
				  finding from an Express Lane agency to more effectively reach out and enroll
				  eligible but uninsured children in the Medicaid Program or the Children's
				  Health Insurance Program (CHIP).
B.
				  Express Lane eligibility is an administrative streamlining option that uses
				  data from other government agencies to identify, enroll and retain children who
				  are eligible for Medicaid or CHIP.
C. Express Lane eligibility shall be utilized
				  for enrollment of uninsured children under the age of 19.
D. These provisions shall not apply to
				  eligibility determinations made after September 30, 2013.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 36:254 and Title XIX of the Social Security
					 Act.